All codes
T635
T635 – T635
OHIP Other Code · Schedule of Benefits
When to Use
- Use T635 for the initial consultation of a patient with a suspected or confirmed diagnosis of a malignant neoplasm when the service is provided by a specialist in medical oncology or hematology.
- Select T635 instead of A005 when the complexity of the oncological assessment requires a detailed review of pathology, staging, and treatment planning beyond a standard consultation.
Common Pitfalls
- Billing T635 in conjunction with a subsequent visit code like A007 on the same day is a common rejection trigger unless specific criteria for a separate, unrelated diagnosis are met.
- Submitting T635 without the required diagnostic code for the malignancy will result in an automatic rejection, as the Ministry requires a specific ICD-9 code for cancer-related billing.
Billing Tips
- Ensure the referral source is clearly documented, as T635 requires a formal written referral from another physician to be eligible for payment.
- If the patient requires a follow-up visit within the same episode of care, transition to the appropriate A-code series to avoid audit flags associated with repeated use of consultation codes.
Provider Fee$86.61
Specialist Fee$86.61
Effective: February 1, 2011
Since Apr 2005, this fee has increased 0.0% vs 10.8% CPI inflation
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.