All codes
T638
T638 – T638
OHIP Other Code · Schedule of Benefits
When to Use
- Use T638 for the initial consultation of a patient with a suspected or confirmed malignancy when the assessment requires a comprehensive review of complex diagnostic data.
- Select T638 when the clinical complexity exceeds the scope of a standard A005 or A007 consultation, specifically requiring a detailed multidisciplinary treatment plan.
Common Pitfalls
- Billing T638 in conjunction with a minor assessment code on the same day is a frequent cause of rejection due to the comprehensive nature of the consultation fee.
- Failure to provide a formal, written consultation report to the referring physician will result in a clawback during an OHIP audit.
Billing Tips
- Ensure the referral source is clearly documented in the patient record, as T638 requires a valid referral from another physician or nurse practitioner to be eligible for payment.
Provider Fee$306.25
Specialist Fee$306.25
Effective: February 1, 2011
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.