All codes
T909
T909 – T909
OHIP Other Code · Schedule of Benefits
When to Use
- Use T909 for a formal consultation requested by a referring physician for a patient with a complex medical condition requiring a comprehensive assessment.
- Use this code when the consultation results in a written report back to the referring physician, distinguishing it from a simple A007 assessment.
- Use T909 when the patient has not been seen by your specialty for the current condition within the last 12 months, meeting the criteria for a new consultation.
Common Pitfalls
- Billing T909 for a follow-up visit on a patient you have already treated for the same condition, which should instead be billed as a subsequent visit code like A005.
- Failing to ensure a formal written request for consultation exists in the patient record, as this is a mandatory requirement for T909 eligibility.
- Submitting T909 when the service provided was merely a transfer of care rather than a consultation, which may lead to claim rejection or audit recovery.
Billing Tips
- Ensure the referring physician's billing number is included in the claim submission to validate the consultation request.
- If the consultation exceeds the time threshold for a standard assessment, consider whether the complexity justifies a premium code or if a different consultation code is more appropriate.
Provider Fee$92.20
Specialist Fee$110.63
Effective: April 1, 2025
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