All codes
T513
T513 – T513
OHIP Other Code · Schedule of Benefits
When to Use
- Use T513 for the surgical repair of a complete or incomplete cleft palate when performed as a primary procedure.
- Apply this code when the surgical intervention involves the closure of the palatal defect, distinct from secondary revisions or pharyngoplasty procedures.
Common Pitfalls
- Billing T513 in conjunction with other palatal procedures that are considered inclusive under the Schedule of Benefits, leading to automatic claim rejection.
- Failing to include the appropriate diagnostic code for cleft palate, which can trigger manual review or audit if the surgical complexity does not align with the billed fee.
Billing Tips
- Ensure that any additional procedures performed during the same operative session are checked against the Schedule of Benefits to determine if they are eligible for separate payment or are considered part of the T513 global fee.
Provider Fee$1,201.50
Specialist Fee$1,201.50
Effective: February 1, 2011
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