All codes
T905
T905 – T905
OHIP Other Code · Schedule of Benefits
When to Use
- Use T905 when performing a formal consultation for a patient referred by another physician or nurse practitioner for a specific clinical problem.
- Select T905 instead of A005 when the patient meets the criteria for a consultation but does not require the higher complexity associated with A007 or A008.
- Apply T905 for a comprehensive assessment of a new patient problem that requires a written report back to the referring practitioner.
Common Pitfalls
- Billing T905 for a follow-up visit on the same patient within 12 months of the initial consultation, which should be billed as a minor assessment (A005 or A007).
- Submitting T905 without a valid referring physician or nurse practitioner billing number, which will trigger an automatic rejection.
- Attempting to bill T905 in conjunction with a procedure code that includes the assessment in its fee, violating the Schedule of Benefits rules.
Billing Tips
- Ensure the referral is documented in the patient chart, including the referring provider's name and billing number, to satisfy audit requirements for T905.
- If the consultation results in a procedure on the same day, bill T905 with the procedure code, ensuring the assessment is distinct and medically necessary.
Provider Fee$139.05
Specialist Fee$166.79
Effective: April 1, 2025
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