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T520
T520 – T520
OHIP Other Code · Schedule of Benefits
When to Use
- Use T520 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive review of diagnostic investigations and treatment planning.
- Select T520 instead of a standard A005 consultation when the complexity of the oncological workup exceeds the requirements of a routine internal medicine or general surgery consult.
Common Pitfalls
- Billing T520 in conjunction with a minor procedure code on the same day often triggers an automatic rejection or audit for unbundling.
- Failing to include the referring physician's billing number or a valid diagnostic code related to the malignancy will result in an immediate claim rejection.
Billing Tips
- Ensure the clinical notes clearly delineate the oncological assessment components to justify the higher fee compared to standard consultation codes like A005 or A007.
Provider Fee$90.09
Specialist Fee$90.09
Effective: February 1, 2011
Since Apr 2005, this fee has increased 0.0% vs 10.8% CPI inflation
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