All codes
T491
T491 – T491
OHIP Other Code · Schedule of Benefits
When to Use
- Use T491 for the initial consultation of a patient with a confirmed diagnosis of a malignant neoplasm when a comprehensive assessment and treatment plan are required.
- Apply this code when the patient is referred by another physician for a formal consultation regarding the management of a new or recurrent malignancy.
- Select T491 instead of a standard A005 or A007 consultation when the complexity of the oncological workup meets the specific criteria for a malignant neoplasm consultation.
Common Pitfalls
- Billing T491 for a follow-up visit or routine monitoring of a stable patient, which should instead be billed as a specific follow-up assessment code.
- Attempting to bill T491 in conjunction with a minor procedure code that is considered inclusive of the consultation assessment under the Schedule of Benefits.
- Failing to ensure the referring physician's information is included, which will trigger an automatic rejection for a consultation claim.
Billing Tips
- Ensure the clinical notes explicitly document the malignant diagnosis and the complexity of the decision-making process to withstand potential post-payment audits.
- Verify that the referral was received in writing or via electronic means prior to the date of service to satisfy the requirements for a formal consultation claim.
Provider Fee$283.60
Specialist Fee$340.36
Effective: April 1, 2025
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.