What is OHIP billing code E494?

E494 is "Debridement (degenerative cartilage)", an OHIP Surgical Assists code from the Ontario Schedule of Benefits (Physician Services).

How much does E494 pay?

The current OHIP fee for E494 is $299.00, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill E494 to OHIP?

E494 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates E494 claims against the Schedule of Benefits rules before submission.

What codes are related to E494?

Codes related to E494 in the Schedule of Benefits include E476, E491, E492, E493, E478, E498, E489, E495.

All codes

E494

E494 – Debridement (degenerative cartilage)

OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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Substantial debridement of one or more focal flaps of unstable degenerative articular cartilage causing mechanical symptoms. This service includes, when rendered, any associated synovectomy, meniscal trimming, and/or chondroplasty. Payment is not eligible for the debridement of cartilage flaps for the purpose of surgical visualization alone. See for full details.

When to Use

Use for arthroscopic debridement of unstable degenerative articular cartilage flaps causing mechanical symptoms in patients with Kellgren-Lawrence grade 3 or 4 osteoarthritis.
Use when performing a procedure that includes synovectomy, meniscal trimming, or chondroplasty as part of the debridement of degenerative cartilage.

Common Pitfalls

Claiming E494 for debridement performed solely for improved surgical visualization, which is explicitly ineligible for payment.
Billing E492 in conjunction with E494, as E492 is strictly prohibited when E494 is claimed.
Failing to document the required six months of failed active non-surgical treatment, which is a mandatory prerequisite for this code.

Billing Tips

Archive pre- and post-procedural arthroscopic photographic images in the patient record to substantiate the intra-articular pathology, especially when claiming with R687.

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Provider Fee$299.00

Effective: April 1, 2025

Category

N. Musculoskeletal System Surgical Procedures

Subcategory

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES

Service Type

Surgical

Code Classes

Musculoskeletal System Surgical Procedures

Pre-Authorization Required

When E494 or E495 are claimed with R687, it is recommended that the intra-articular pathology be documented with pre- and post-procedural photographic images taken during arthroscopy which are archived in the permanent medical record where possible.

E476 E491 E492 E493 E478 E498 E489 E495 R687

Prior approval may be granted for E494 or E495 in patients with Kellgren-Lawrence grade 3 or 4 osteoarthritis (see Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res. 2016 Aug; 474(8):1886-93) if the clinical record supports: a. Significant functional impairment caused by an unstable articular chondral flap or degenerative meniscal tear which has not responded to a minimum of six months active non-surgical treatment; and b. the patient is not a current candidate for knee realignment or arthroplasty.

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