All codes
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
Since Sep 2011, this fee has increased 0.0% vs 35.5% CPI inflation
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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