All codes
T761
T761 – T761
OHIP Other Code · Schedule of Benefits
When to Use
- Use T761 for the initial assessment of a patient with a suspected or confirmed diagnosis of a malignant neoplasm when the service is provided by a consultant.
- Apply this code when performing a comprehensive consultation for a new cancer diagnosis that requires a formal written report to the referring physician.
- Select T761 instead of a standard A005 consultation when the complexity of the oncological assessment meets the specific criteria for a malignant neoplasm consultation.
Common Pitfalls
- Billing T761 for a follow-up visit or a routine check-up, which must instead be billed as a subsequent visit code like A007.
- Submitting T761 without a valid referring physician number, as this code strictly requires a formal referral to be eligible for payment.
- Attempting to bill T761 in conjunction with a minor assessment code on the same day, which will trigger an automatic rejection for duplicate services.
Billing Tips
- Ensure the clinical note explicitly documents the malignant diagnosis and the consultation request details to withstand potential post-payment audits.
- If the patient requires a procedure on the same day, ensure the procedure is billed with the appropriate diagnostic code to avoid conflict with the T761 consultation fee.
Provider Fee$74.25
Specialist Fee$74.25
Effective: February 1, 2011
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