All codes
T904
T904 – T904
OHIP Other Code · Schedule of Benefits
When to Use
- Use T904 when performing a formal consultation for a patient referred by another physician or nurse practitioner for a specific clinical problem.
- Select T904 when the patient has not been seen by you for the same or related condition within the preceding 12 months.
- Apply T904 for a comprehensive assessment that includes a review of the referral letter, history, physical examination, and a written report back to the referring provider.
Common Pitfalls
- Billing T904 when the patient is a return visit for a follow-up, which should instead be billed as a subsequent assessment code like A007.
- Submitting T904 without a valid referring physician number, which will trigger an automatic rejection from OHIP.
- Attempting to bill T904 on the same day as a minor procedure or other assessment code that is not specifically permitted under the Schedule of Benefits.
Billing Tips
- Ensure the referral is documented as a formal request for consultation to distinguish it from a simple transfer of care or a routine visit.
- If the consultation results in a decision to perform a procedure, ensure the T904 is billed as the primary service and the procedure is billed with the appropriate diagnostic code.
Provider Fee$92.20
Specialist Fee$110.63
Effective: April 1, 2025
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.