All codes
T562
T562 – T562
OHIP Other Code · Schedule of Benefits
When to Use
- Use T562 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 closure of the palatal defect, distinct from secondary revisions or pharyngoplasty procedures.
Common Pitfalls
- Billing T562 in conjunction with other palatal procedures that are considered inclusive under the Schedule of Benefits, leading to automatic rejection for unbundling.
- Failing to include the necessary diagnostic codes for congenital anomalies, which can trigger manual review or rejection for lack of medical necessity.
Billing Tips
- Ensure that the operative report clearly distinguishes the primary repair (T562) from any concurrent procedures, as the Ministry may audit claims where multiple surgical codes are billed on the same date.
Provider Fee$1,321.18
Specialist Fee$1,321.18
Effective: February 1, 2011
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