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R108
R108 – Simple mastectomy
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A simple mastectomy performed on a female patient, which may or may not include a biopsy. As per the commentary on page , for patients who have been approved by OHIP for mastectomy related to sex-reassignment surgery, this fee code may apply, potentially in conjunction with R120 for nipple preservation and grafting.
When to Use
- Use R108 for a standard simple mastectomy where the breast tissue is removed but the nipple-areola complex is not preserved.
- Use R108 in combination with R120 when performing a simple mastectomy for gender-affirming surgery that requires nipple preservation and free nipple grafting.
- Choose R108 instead of R117 when the surgical technique involves a simple mastectomy rather than a subcutaneous mastectomy with nipple preservation.
Common Pitfalls
- Billing R108 alongside R117 is a duplication error, as these represent different surgical approaches to mastectomy.
- Failing to document the specific requirement for a second assistant will lead to automatic rejection, as R108 is not on the pre-approved list for multiple assistants.
- Attempting to claim E420 trauma premiums for elective gender-affirming mastectomies will result in claim rejection.
Billing Tips
- When performing gender-affirming surgery, ensure R120 is billed as a secondary procedure to R108 to capture the nipple preservation and grafting component.
- If a second assistant is medically necessary for R108, ensure a letter of justification from the surgeon is submitted to the Ministry to bypass the standard rejection.
Provider Fee$330.00
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
M. Integumentary System Surgical Procedures
Subcategory
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Integumentary System Surgical Procedures
Sex Restriction
Female
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