What is OHIP billing code R109?

R109 is "Mastectomy, radical or modified radical", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R109 pay?

The current OHIP fee for R109 is $780.00, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill R109 to OHIP?

R109 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R109 claims against the Schedule of Benefits rules before submission.

All codes

R109

R109 – Mastectomy, radical or modified radical

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

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Mastectomy, radical or modified radical, with or without biopsy, as described on page of the Schedule. The fee for the surgeon (<suffix>A</suffix>) is a flat rate. The assistant fee (<suffix>B</suffix>) is based on 6 basic units plus time units. The anaesthetist fee (<suffix>C</suffix>) is based on 7 basic units plus time units. As per commentary on page , skin grafts are eligible for payment in addition to R109.

When to Use

Use R109 for a radical or modified radical mastectomy, which includes the removal of breast tissue and axillary lymph node dissection.
Use this code when performing a mastectomy that includes a biopsy, as the biopsy is considered included in the flat rate for R109.

Common Pitfalls

Do not bill R109 in conjunction with other breast excision codes, as R109 is intended to be the comprehensive procedure code for a radical or modified radical mastectomy.
Ensure the surgical report clearly differentiates the mastectomy from any separate reconstructive procedures, as billing for additional procedures requires careful adherence to the Schedule of Benefits to avoid rejection.

Billing Tips

Always bill skin grafts as a separate, eligible procedure in addition to R109 if performed during the same operative session, as explicitly permitted by the Schedule of Benefits.
Ensure all applicable age-based premiums or after-hours premiums (e.g., E409, E410) are applied to the procedural fee if the clinical criteria for the patient or timing of the surgery are met.

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Provider Fee$780.00

Surgical Assistant Fee$77.46

Anaesthetist Fee$111.72

Non-Anaesthetist Fee$111.72

Effective: April 1, 2026

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