All codes
T925
T925 – T925
OHIP Other Code · Schedule of Benefits
When to Use
- Use T925 for the initial consultation of a patient referred by another physician for a specific diagnostic assessment or management plan.
- Apply this code when the consultation occurs in a hospital or office setting, provided the referral requirements of the Schedule of Benefits are met.
- Choose T925 over A005 when the patient requires a comprehensive specialist evaluation that exceeds the scope of a standard intermediate assessment.
Common Pitfalls
- Billing T925 for a patient who has been seen by the same physician or a partner in the same group for the same diagnosis within the preceding 12 months, which should be billed as a repeat assessment.
- Failing to document a formal written referral from the referring physician, which is a mandatory requirement for all consultation codes.
- Submitting T925 without the referring physician's billing number, which will trigger an automatic rejection.
Billing Tips
- Ensure the consultation note clearly outlines the diagnostic opinion and recommendations provided to the referring physician to justify the higher fee compared to A005.
- If the consultation results in a procedure, ensure the procedure is billed separately using the appropriate surgical or diagnostic code, as T925 covers the cognitive assessment only.
Provider Fee$67.87
Specialist Fee$81.42
Effective: February 1, 2011
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