All codes
T625
T625 – T625
OHIP Other Code · Schedule of Benefits
When to Use
- Use T625 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive history, physical examination, and review of diagnostic investigations.
- Apply this code when providing a formal specialist consultation for a patient referred by another physician or nurse practitioner to establish a management plan for a new oncological diagnosis.
Common Pitfalls
- Billing T625 when the patient has already been seen for the same condition by the same specialist within the previous 12 months, which should instead be billed as a repeat consultation or a subsequent visit.
- Submitting T625 without a valid referring physician number or failing to include the required written consultation report, which will trigger an automatic rejection or audit recovery.
Billing Tips
- Ensure the consultation report is sent to the referring physician within 48 hours to support the claim, as OHIP may audit the timeliness of the communication for high-value codes like T625.
- If the patient requires an urgent assessment on the same day as the referral, ensure the 'urgent' indicator is flagged to justify the consultation fee over a standard office visit code.
Provider Fee$192.80
Specialist Fee$192.80
Effective: February 1, 2011
Since Jan 2004, this fee has increased 0.0% vs 14.3% CPI inflation
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