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T480
T480 – T480
OHIP Other Code · Schedule of Benefits
When to Use
- Use T480 for the initial consultation of a patient with a confirmed diagnosis of a malignant neoplasm when referred by another physician or nurse practitioner.
- Apply this code when the consultation involves a comprehensive assessment, staging, and development of a complex treatment plan for a new cancer diagnosis.
Common Pitfalls
- Billing T480 for a follow-up visit or a routine review of a patient already under your care for the same malignancy, which should be billed as an A007 or equivalent.
- Submitting T480 without a valid referring physician number or failing to provide a written consultation report to the referring provider, which triggers automatic rejection.
- Attempting to bill T480 in conjunction with a minor procedure code on the same day without clear documentation of a separate, distinct clinical assessment.
Billing Tips
- Ensure the referral request specifically mentions the suspicion or diagnosis of malignancy to justify the higher complexity fee compared to a standard A005 consultation.
- If the consultation results in a decision to perform a major surgical procedure, ensure the T480 is billed as the assessment fee and not bundled into the surgical fee.
Provider Fee$339.75
Specialist Fee$339.75
Effective: April 1, 2025
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