What is OHIP billing code E564?

E564 is "Revision of elbow arthroplasty", an OHIP Surgical Assists code from the Ontario Schedule of Benefits (Physician Services).

How much does E564 pay?

E564 is a percentage premium: it adds 35% to the fee of the eligible service it is billed with, per the Ontario Schedule of Benefits.

How do I bill E564 to OHIP?

E564 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates E564 claims against the Schedule of Benefits rules before submission.

All codes

E564

E564 – Revision of elbow arthroplasty

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

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This code represents a 35% increase to the fee of a primary arthroplasty procedure to account for the increased complexity of a revision. This premium is applicable to revisions of prostheses in the following areas: - Hand and Wrist () - Elbow () - Foot and Ankle () It is intended to be billed in addition to the primary arthroplasty code. Note: This add-on is not eligible for payment with R694 (ankle liner replacement).

When to Use

Use E564 when performing a revision of a previously implanted total elbow arthroplasty to address mechanical failure, loosening, or infection.
Apply this code when performing a revision procedure on a previously placed ankle or foot prosthesis, provided it is not the excluded R694 liner replacement.
Use E564 when revising a primary hand or wrist arthroplasty, ensuring it is billed as an add-on to the specific primary procedure code.

Common Pitfalls

Attempting to bill E564 alongside R694 will result in an automatic rejection, as the Schedule of Benefits explicitly prohibits this combination.
Billing E564 for a primary arthroplasty procedure is a common audit trigger; it must only be applied to revision surgeries.
Failing to link E564 to the primary surgical procedure code on the same claim can lead to payment processing errors.

Billing Tips

Ensure E564 is submitted on the same claim as the primary arthroplasty code to trigger the 35% percentage increase correctly.
Verify that the procedure performed meets the definition of a revision rather than a simple component exchange, as some minor exchanges may not qualify for the E564 premium.

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Percentage Premium: 0.35%

This code applies a percentage increase to the base procedure fee

Provider Fee$0.01

Effective: July 1, 2013

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