All codes
T601
T601 – T601
OHIP Other Code · Schedule of Benefits
When to Use
- Use T601 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive review of complex diagnostic data.
- Apply this code when providing a formal consultation for a patient referred by another physician for the management of a new cancer diagnosis, provided the patient has not been seen by you for the same condition in the last 12 months.
Common Pitfalls
- Billing T601 when the service provided is a repeat visit or follow-up, which should instead be billed using a subsequent visit code like A601.
- Submitting T601 without a valid referring physician number, as this code strictly requires a formal referral to be eligible for payment.
- Attempting to bill T601 in conjunction with a minor procedure code on the same day, which often triggers a rejection due to the comprehensive nature of the consultation fee.
Billing Tips
- Ensure your clinical notes explicitly state the referring physician's name and the specific clinical question asked to satisfy the requirements for a formal consultation claim.
- If the consultation results in a decision to perform a major surgery, ensure you are not also billing a separate assessment fee on the same day, as the consultation fee is intended to cover the decision-making process.
Provider Fee$236.80
Specialist Fee$236.80
Effective: February 1, 2011
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