What is OHIP billing code E486?

E486 is "Nipple sparing mastectomy add-on", an OHIP Surgical Assists code from the Ontario Schedule of Benefits (Physician Services).

How much does E486 pay?

The current OHIP fee for E486 is $0.01, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill E486 to OHIP?

E486 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates E486 claims against the Schedule of Benefits rules before submission.

What codes are related to E486?

Codes related to E486 in the Schedule of Benefits include R117, R108, E517, E505.

All codes

E486

E486 – Nipple sparing mastectomy add-on

OHIP Surgical Assists Code · Schedule of Benefits

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An add-on fee for the operating surgeon when performing a nipple sparing technique in conjunction with a skin sparing mastectomy (R117).

When to Use

Use E486 when performing a nipple-sparing mastectomy in conjunction with R117 for patients undergoing immediate breast reconstruction.
Apply this code specifically when the nipple-areolar complex is preserved during a skin-sparing mastectomy for malignancy or high-risk prophylaxis.

Common Pitfalls

Billing E486 with R108 (simple mastectomy) will result in a rejection, as it is strictly an add-on to R117.
Attempting to claim E486 when the nipple-areolar complex is excised or removed during the procedure is an audit risk for inappropriate billing.

Billing Tips

Ensure E486 is submitted with the suffix 'A' attached to the R117 claim to trigger the 30% premium calculation correctly.

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Provider Fee$0.01

Effective: April 1, 2026

Service Type

Surgery

Code Classes

Premium

R117Skin sparing mastectomy performed with immediate breast reconstruction for malignancy or prophylaxis in high-risk female patients R108Simple mastectomy E517Immediate postmastectomy superficial chest wall reconstruction (add-on to R108)E505Limited axillary node sampling (add-on to R108 or R117)

E486 is a percentage-based add-on (30% of the surgeon's fee for R117).

Not eligible for payment as a virtual care service (not listed in Appendix J).

Does not provide additional basic units for the surgical assistant or anaesthesiologist.

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