All codes
T510
T510 – T510
OHIP Other Code · Schedule of Benefits
When to Use
- Use T510 for the initial consultation of a patient referred by a physician or nurse practitioner for a complex assessment that exceeds the scope of a standard A007 consultation.
- Apply this code when the clinical complexity requires a comprehensive review of records and a detailed report to the referring provider, distinguishing it from the lower-valued A005 or A007 codes.
Common Pitfalls
- Billing T510 without a valid written referral from a primary care provider or another specialist will result in an automatic rejection.
- Submitting T510 on the same day as a minor procedure or a subsequent visit for the same condition often triggers a claim rejection due to duplicate service rules.
- Failure to document the specific clinical complexity that justifies the higher fee of T510 over a standard consultation code makes the claim vulnerable to recovery during a Ministry audit.
Billing Tips
- Ensure the referring physician's billing number is included in the claim submission to avoid administrative rejections.
- If the consultation results in a decision to perform a procedure, ensure the consultation note clearly justifies the necessity of the assessment independent of the procedure itself.
Provider Fee$238.85
Specialist Fee$238.85
Effective: February 1, 2011
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