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E961

E961LeFort I advancement - in two segments

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

This code represents the additional fee for performing a LeFort I advancement osteotomy in two segments. It must be billed in conjunction with the primary procedure code, R379 (LeFort I advancement in one segment).

When to Use

  • Use E961 when the maxilla is surgically divided into two distinct segments during a LeFort I advancement to address transverse deficiencies or arch width discrepancies.
  • Apply this code strictly as an add-on when the primary procedure R379 is performed and the surgical plan necessitates a split-segment osteotomy.

Common Pitfalls

  • Billing E961 as a standalone procedure will result in an automatic rejection, as it requires the presence of R379 on the same claim.
  • Confusing E961 with E962, which is reserved for three-segment osteotomies, will trigger a billing error or audit flag for incorrect complexity coding.

Billing Tips

  • Ensure the operative report explicitly documents the division of the maxilla into two segments to justify the additional fee beyond the base R379 procedure.
Provider Fee$296.60

Effective: April 1, 2025

Category

N. Musculoskeletal System Surgical Procedures

Subcategory

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES

Service Type

Procedure

Code Classes

Musculoskeletal System Surgical Procedures

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