All codes
T496
T496 – T496
OHIP Other Code · Schedule of Benefits
When to Use
- Use T496 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive review of clinical data and treatment planning.
- Select T496 when providing a formal specialist consultation for a complex oncology case that does not meet the specific criteria for a multi-disciplinary cancer conference code.
Common Pitfalls
- Billing T496 in conjunction with a minor assessment code (A007) on the same day for the same patient will trigger an automatic rejection for duplicate service.
- Failing to ensure the referring physician has provided a formal written request, as T496 requires a valid referral to be eligible for payment under the Schedule of Benefits.
Billing Tips
- Ensure the clinical note clearly reflects the complexity of the oncology assessment to justify the T496 fee over a standard consultation code if audited.
Provider Fee$124.03
Specialist Fee$124.03
Effective: April 1, 2025
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