All codes
T535
T535 – T535
OHIP Other Code · Schedule of Benefits
When to Use
- Use T535 for the initial consultation of a patient with a suspected or confirmed malignancy when the service is provided by a specialist in medical oncology or hematology.
- Apply this code when the clinical encounter includes a comprehensive review of pathology, staging, and the formulation of a complex multi-modality treatment plan.
Common Pitfalls
- Billing T535 for a follow-up visit instead of a consultation, which will trigger a rejection or audit recovery; use the appropriate subsequent visit code instead.
- Submitting T535 without the required referring physician information, as consultations require a formal request from another practitioner to be valid under the Schedule of Benefits.
Billing Tips
- Ensure the consultation report is dated and sent to the referring physician, as the Ministry may audit the existence of this correspondence to validate the T535 claim.
Provider Fee$174.15
Specialist Fee$174.15
Effective: February 1, 2011
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