What is OHIP billing code R086?

R086 is "Intermediate, large areas skin graft", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R086 pay?

The current OHIP fee for R086 is $259.10, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R086 to OHIP?

R086 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R086 claims against the Schedule of Benefits rules before submission.

What codes are related to R086?

Codes related to R086 in the Schedule of Benefits include R990, R993, E006B, E006C, R030, R038.

All codes

R086

R086 – Intermediate, large areas skin graft

OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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This service is for the excision of the submandibular gland. The fee for this surgical procedure (suffix A) includes the major pre-operative visit (consultation or assessment at which the decision to operate is made), the operation itself, and the normal course of post-operative care. In addition to the - common elements, this surgical service includes specific elements as defined in the preamble, such as preparing the patient, performing the procedure, managing post-procedure care until the first post-operative visit, and arranging follow-up. For details on surgical assistant (suffix B) and anaesthesia (suffix C) services, refer to the - and - sections of the General Preamble, respectively. If the operation is cancelled after surgery has commenced, the amount payable is calculated by adding the listed procedural basic units plus time units. For cancelled surgery before commencement, see E006B (assistant) and E006C (anaesthetist).

When to Use

Use R086 for the definitive surgical excision of the submandibular gland when performed as a primary procedure.
Use this code for the procedure itself, which inherently includes the pre-operative decision-making visit and routine post-operative care.

Common Pitfalls

Billing R086 in conjunction with R117 is prohibited as they are restricted codes; ensure no overlap in surgical intent.
Assuming automatic payment for a second surgical assistant; unlike other procedures, R086 requires a formal letter of justification to a medical consultant for second assistant approval.
Failing to account for the inclusion of the pre-operative assessment in the R086 fee, which precludes billing a separate consultation or assessment code for the decision to operate.

Billing Tips

If the surgery is cancelled after the procedure has commenced, bill using the procedural basic units plus time units rather than the flat fee.
Always verify the patient's age and the timing of the procedure to ensure all applicable age-based and after-hours premiums are appended to the claim.

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Provider Fee$259.10

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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