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T651

T651T651

OHIP Other Code · Schedule of Benefits

When to Use

  • Use T651 for the initial assessment and management of a patient presenting with a specific acute condition when a comprehensive consultation (A005) is not warranted.
  • Apply T651 when providing a focused reassessment for a patient who has returned with a new, distinct clinical issue that falls outside the scope of a standard follow-up visit (A007).
  • Utilize T651 for urgent, non-emergency evaluations that require a higher level of complexity than a routine office visit but do not meet the criteria for a formal specialist consultation.

Common Pitfalls

  • Billing T651 on the same day as a comprehensive consultation (A005) for the same patient will result in a rejection for duplicate service.
  • Submitting T651 for routine follow-up care that should be billed under A007 is a common audit trigger for over-billing.
  • Failure to include the appropriate diagnostic code that justifies the complexity of the T651 service often leads to automatic claim rejection.

Billing Tips

  • Ensure the clinical note clearly distinguishes the complexity of the T651 encounter from a standard A007 visit to withstand potential Ministry audits.
  • Always verify that no other procedural or assessment codes billed on the same day are considered 'inclusive' of the T651 service to avoid payment recovery.
Provider Fee$54.89
Specialist Fee$62.72

Effective: April 1, 2025

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