E544 – Cast bracing with closed reduction
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A premium that increases the fee for a closed reduction by 40% when cast bracing is utilized as part of the procedure. This is listed under the Fixation subsection of Musculoskeletal System Surgical Procedures on page of the Schedule. Payment Rule: - E544 is not eligible for payment when a prefabricated cast, brace or splint is used.
When to Use
- Use E544 when performing a closed reduction of a fracture that requires the custom fabrication of a functional cast brace, such as a Sarmiento brace, rather than a standard static cast.
- Apply this premium when the complexity of the fracture management necessitates a custom-molded brace to maintain alignment during the healing process.
Common Pitfalls
- Billing E544 when using off-the-shelf prefabricated braces or splints, which explicitly violates the Schedule of Benefits and triggers automatic rejection.
- Failing to document the specific custom fabrication process, which is required to justify the premium over standard casting codes like E555 or E569.
Billing Tips
- Ensure the primary procedure code for the closed reduction is billed alongside E544 to trigger the 40% premium calculation correctly.
Percentage Premium: 0.4%
This code applies a percentage increase to the base procedure fee
Effective: July 1, 2013
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
PercentageIncrease
Other Premiums (including After Hours Procedure Premiums), Musculoskeletal System Surgical Procedures
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