All codes
T546
T546 – T546
OHIP Other Code · Schedule of Benefits
When to Use
- Use T546 for the surgical repair of a complete or incomplete cleft palate, typically performed by a plastic surgeon or otolaryngologist.
- Apply this code when the procedure involves the formal closure of the palatal defect, distinct from minor revisions or secondary procedures covered under different codes.
Common Pitfalls
- Billing T546 in conjunction with other surgical procedures that are considered part of the global surgical package, leading to automatic rejection for unbundling.
- Failing to append the appropriate diagnostic code for congenital cleft palate, which may trigger a manual review or rejection for lack of medical necessity.
Billing Tips
- Ensure that any additional procedures performed during the same operative session are reviewed against the Schedule of Benefits to determine if they are eligible for separate payment or are considered inclusive to the T546 fee.
Provider Fee$564.84
Specialist Fee$564.84
Effective: February 1, 2011
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