Use this article when a clerk is asking:
Is this dental service insured by OHIP?
Can I bill this as a hospital consultation?
Why did the claim reject or pay zero?
What basic claim fields should I verify before submission?
Most dental billing errors happen because one of the following is wrong:
the service was not billed in the correct setting,
the wrong consultation/follow-up code was chosen,
required claim fields were missing,
the same code was billed too often on the same day,
or the claim was submitted too late.
OHIP covers certain hospital dental surgical services. Clerks should treat the Ontario dental schedule as the main coding source for hospital-based dental billing.
A consultation must truly be “in a hospital.” A private dental office located inside a hospital building does not count as “in a hospital” for consultation billing.
For billing workflow, Ontario’s technical specifications say:
all dental services require a Master Number,
and all hospital consultations require both a Master Number and a Referring Physician or NP Provider Number.
That makes these fields part of the first quality-control check for clerks.
Any T650 or T651 billed more than once for the same patient, same dentist, same day is payable at zero.
Ontario’s current submission rule is a three-month submission period from the date the service was rendered in Ontario. A correct claim can still become a problem if it is submitted late.
T650 — hospital consultation
T651 — follow-up assessment within 12 months for the same diagnosis
T652 — visit to an admitted bed patient
T653 — examination under general anesthesia
T654 — imaging add-on to T653 when applicable
Check that the service belongs in the hospital dental schedule.
Check that the location matches the code.
Check the Master Number.
Check the referring provider field for consultations.
Check for same-day duplicate T650/T651 billing.
Check whether the claim is still inside the submission timeframe.
Check whether the claim needs manual review, supporting documentation, or prior approval instead of routine submission.
Example 1 — valid consultation
Patient is seen by the dentist in hospital after a proper referral. Bill T650 if the record supports a true hospital consultation.
Example 2 — invalid consultation setting
Patient is seen in a private dental office located inside the hospital building. Do not assume T650 is valid just because the office is physically in the hospital.
Example 3 — zero-pay duplicate
Same dentist bills two T651 services for the same patient on the same day. The excess T651 should be expected to pay at zero.
Example 4 — stale-date risk
Claim is otherwise correct, but submitted after the three-month billing window. The claim is now at risk of rejection or extra corrective work.