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E514
E514 – Immediate breast reconstruction following mastectomy
OHIP Surgical Assists Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
When to Use
- Use E514 when performing an immediate tissue expander or implant placement (e.g., R118) during the same operative session as the mastectomy.
- Use E514 when performing immediate autologous reconstruction (e.g., R125 or R156) immediately following the completion of the mastectomy under the same anaesthetic.
Common Pitfalls
- Billing E514 without one of the six mandatory primary codes (R118, R125, R064, R156, R008, or R155) will result in an automatic rejection.
- Claiming E514 for delayed reconstruction procedures performed in a separate operative session will trigger an audit, as it is strictly defined for immediate reconstruction only.
Billing Tips
- Ensure E514 is submitted on the same claim as the primary reconstruction code to avoid processing errors.
- Verify that the operative report explicitly states the reconstruction was performed immediately following the mastectomy to support the use of this add-on fee.
Provider Fee$200.00
Effective: April 1, 2025
Category
M. Integumentary System Surgical Procedures
Subcategory
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Service Type
Procedure
Code Classes
Integumentary System Surgical Procedures
E514 is only eligible for payment if post-mastectomy breast reconstruction is performed immediately following mastectomy during the same anaesthesia.
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