All codes
T628
T628 – T628
OHIP Other Code · Schedule of Benefits
When to Use
- Use T628 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive history and physical examination.
- Apply this code when providing a formal specialist opinion for a new oncology patient referral that does not meet the complexity requirements for a more intensive consultation code like A625.
Common Pitfalls
- Billing T628 for a follow-up visit instead of a subsequent visit code (e.g., A622) will trigger an automatic rejection or audit flag.
- Submitting T628 on the same day as a minor procedure or another consultation for the same patient without a valid diagnostic code indicating a separate clinical issue will lead to payment denial.
Billing Tips
- Ensure the referral source is clearly documented in the chart, as T628 requires a formal request from another physician or nurse practitioner to be valid for payment.
- If the patient requires a more extensive assessment involving complex decision-making or multidisciplinary planning, consider if A625 provides a higher value before defaulting to T628.
Provider Fee$80.10
Specialist Fee$80.10
Effective: February 1, 2011
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