OHIP Billing Codes

Specialty: Shoulder Arm And Chest

Code Description Fee
D014 Dislocations Acromioclavicular/sternoclavicular no reduction $69.15
D015 Dislocations Glenohumeral joint closed reduction without anaesthetic $50.20
D016 Dislocations Glenohumeral joint closed reduction with anaesthetic $113.65
D017 Dislocations Glenohumeral joint open reduction, early $330.35
D025 Dislocations Acromioclavicular/sternoclavicular closed with anaesthetic $137.25
F023 Fractures Radius and ulna Monteggia open reduction of ulna plus closed reduction radial head $425.00
F042 Fractures Shaft no reduction $69.15
F043 Fractures Shaft closed reduction $150.55
F044 Fractures Shaft open reduction $668.70
F047 Fractures Tuberosity no reduction $69.15

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F049 Fractures Tuberosity open reduction (without cuff tear) $296.40
F050 Fractures Neck with dislocation of head no reduction $69.15
F051 Fractures Neck with dislocation of head closed reduction $187.50
F052 Fractures Neck with dislocation of head open reduction $532.25
F053 Fractures Neck without dislocation of head no reduction $69.15
F054 Fractures Neck without dislocation of head closed reduction $136.30
F055 Fractures Neck without dislocation of head open reduction $525.30
F110 Fractures Clavicle closed reduction with anaesthetic $63.45
F118 Fractures Clavicle open reduction $467.95
F119 Fractures Scapula no reduction $69.15
F121 Fractures Scapula open reduction $389.05
F123 Fractures Sternum closed reduction $118.30
F124 Sternum open reduction pleura open (see General Preamble GP12) $118.30
F125 Sternum pleura closed (see General Preamble GP12) I.C $118.30
F131 Ribs pleura closed (see General Preamble GP12) I.C $118.30
R214 Clavicle or Acromion Malignant tumour with reconstruction $494.10
R219 Phalanx/metacarpal/carpus incision and drainage $186.60
R222 Incision and Drainage Humerus/clavicle/scapula $267.90
R223 Incision and Drainage Saucerization with bone graft $395.70
R225 Incision and Drainage Sequestrectomy $296.40
R228 Acute $308.65
R235 Osteotomy glenoid $284.95
R240 Revision total arthroplasty shoulder $961.90
R260 Osteotomy humerus $298.25
R292 Humerus Head $305.75
R294 Tumours Bone tumours exostosis $168.50
R295 Tumours Bone tumours simple excision $295.30
R297 Humerus Malignant tumour with reconstruction $694.80
R298 Clavicle or Acromion Simple (includes ligament) $215.85
R298 Clavicle or Acromion Simple (includes ligament) $215.85
R325 Pseudoarthrosis Humerus $353.10
R329 Pseudoarthrosis Clavicle $274.50
R353 Muscles/soft tissues Scapulopexy congenital elevation $392.90
R353 Muscles/soft tissues Scapulopexy congenital elevation $392.90
R401 Dislocations Glenohumeral joint open reduction, recurrent $428.10
R411 Shoulder $228.15
R411 Shoulder $228.15
R416 Rotator cuff exploration includes acromioplasty, excision of coracoacromial ligament and subacromial bursa but excludes simple excision of clavicle $211.05
R422 Joint Synovectomy and debridement $433.65
R438 Humeral prosthesis $458.25
R467 Shoulder $478.05
R472 Dislocations Glenohumeral joint open reduction, late $592.60
R487 Total prosthesis $785.50
R498 Removal prosthesis/no replacement $405.20
R512 Joint Excision of subacromial bursa (not to be claimed with R416, R593 or R594) $215.85
R521 Muscles and tendons radical, e.g. muscle slide $320.90
R522 Muscle simple $196.90
R523 Muscle complex $494.10
R526 Sternomastoid $302.00
R527 Muscles/soft tissues Muscle transplant pectoralis major $443.00
R527 Muscles/soft tissues Muscle transplant pectoralis major $443.00
R568 Muscles/soft tissues Trapezius/sternomastoid transplant $345.45
R568 Muscles/soft tissues Trapezius/sternomastoid transplant $345.45
R589 Muscles/soft tissues Tendon repair or release biceps $231.95
R589 Muscles/soft tissues Tendon repair or release biceps $231.95
R593 Muscles/soft tissues Rotator cuff repair simple, endtoend or sidetoside (includes acromioplasty, excision of coracoacromial ligament and subacromial bursa ) $352.30
R593 Muscles/soft tissues Rotator cuff repair simple, endtoend or sidetoside (includes acromioplasty, excision of coracoacromial ligament and subacromial bursa ) $352.30
R594 Muscles/soft tissues Rotator cuff repair complex (includes implantation into bone, and as required, acromioplasty, excision of coracoacromial ligament, subacromial bursa and excision of distal clavicle) $508.30
R594 Muscles/soft tissues Rotator cuff repair complex (includes implantation into bone, and as required, acromioplasty, excision of coracoacromial ligament, subacromial bursa and excision of distal clavicle) $508.30
R596 Dislocations Acromioclavicular/sternoclavicular late $292.45
R615 High humerus $376.75
R616 Shoulder disarticulation $380.60
R617 Forequarter $500.80
R641 Clavicle or Acromion Major tumour $296.40
R684 Shoulder arthroscopy setup, includes when rendered debridement, synovectomy, removal of loose body(ies) and/or screw, drilling of defect or microfracture, and/ or synovial biopsy $408.05
R685 Muscles/soft tissues Tendon release with tenodesis biceps $320.90
R685 Muscles/soft tissues Tendon release with tenodesis biceps $320.90
R956 Pseudoarthrosis Humerus circular external fixation $297.25
R957 Osteotomy Single level correction circular external fixation $520.60
R958 Osteotomy Double level correction circular external fixation $651.25
R959 Osteotomy Bone transport circular external fixation (less than or equal to 6 cm) $668.30
R960 Osteotomy Bone transport circular external fixation (greater than 6 cm) $779.15
R961 Osteotomy Humeral lengthening circular external fixation (less than or equal to 6 cm) $446.80
R962 Osteotomy Humeral lengthening circular external fixation (greater than 6 cm) $668.30
Z214 Bone open biopsy or taking of bone graft by other than operating surgeon $147.70
Z219 Muscle needle biopsy, soft tissue, per site $31.85
Z220 Bone needle/punch, xray control $91.50
Z223 Manipulation under general anaesthetic $50.20
Z226 Soft tissue or bursa, incision and drainage $99.30
Z228 Soft tissue open $99.30

The information presented on this page is general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBCx or its affiliates.

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