All codes
T560
T560 – T560
OHIP Other Code · Schedule of Benefits
When to Use
- Use T560 for the definitive 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, distinguishing it from minor revisions or secondary procedures coded under different fee schedule items.
Common Pitfalls
- Billing T560 in conjunction with other surgical codes for the same site may trigger a 'duplicate service' or 'incidental procedure' rejection unless the services are distinct and clearly documented as separate operative sessions.
- Failing to account for the global surgical period associated with T560, which precludes billing for routine post-operative follow-up visits within the specified timeframe.
Billing Tips
- Ensure the operative report explicitly details the complexity of the repair to support the high-value fee if audited against standard cleft repair benchmarks.
Provider Fee$1,321.18
Specialist Fee$1,321.18
Effective: February 1, 2011
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