What is OHIP billing code E538?

E538 is "Each additional", an OHIP Surgical Assists code from the Ontario Schedule of Benefits (Physician Services).

How much does E538 pay?

The current OHIP fee for E538 is $38.00, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill E538 to OHIP?

E538 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates E538 claims against the Schedule of Benefits rules before submission.

What codes are related to E538?

Codes related to E538 in the Schedule of Benefits include R456.

All codes

E538

E538 – Each additional

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

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E538 is an add-on code for use with R456 (Metatarsophalangeal interposition - single). It is claimed for each additional metatarsophalangeal interposition arthroplasty performed during the same operative session.

When to Use

Use E538 for each additional metatarsophalangeal joint beyond the first when performing multiple interposition arthroplasties during the same operative session.
Claim E538 in conjunction with the primary code R456 when the patient requires surgical correction of multiple toes.

Common Pitfalls

Billing E538 without a corresponding R456 claim on the same date of service will result in an automatic rejection.
Attempting to use E538 for the first joint treated is incorrect; the first joint must always be billed under the primary code R456.
Over-claiming the number of units for E538; ensure the units claimed match the number of additional joints treated beyond the initial R456 procedure.

Billing Tips

Ensure the total number of units for E538 accurately reflects the count of additional joints, as this is a flat-fee add-on per joint.
If performing bilateral procedures, ensure the primary R456 is billed with the appropriate side indicator and E538 is used for all subsequent joints treated in the same session.

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Provider Fee$38.00

Effective: April 1, 2025

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