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R110

R110 – Reduction mammoplasty (female, to include nipple transplantation or grafting, if rendered) - unilateral

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

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A unilateral reduction mammoplasty performed on a female patient, which includes nipple transplantation or grafting if rendered. This procedure is specifically for cases other than a balancing procedure related to post-mastectomy breast reconstruction. According to the commentary on page of the Schedule of Benefits, prior authorization of payment from the Ministry of Health is a mandatory requirement for this service to be insured.

When to Use

  • Use for symptomatic macromastia where the procedure is medically necessary and has received formal prior authorization from the Ministry of Health.
  • Use for unilateral reduction mammoplasty in female patients when the procedure is not associated with post-mastectomy breast reconstruction.

Common Pitfalls

  • Failure to secure and document Ministry of Health prior authorization before the procedure will result in automatic claim rejection.
  • Billing R110 in conjunction with R143 or R144 is prohibited and will trigger a rejection as these codes are mutually exclusive.
  • Attempting to use R110 for balancing procedures post-mastectomy is incorrect; these cases fall under different reconstruction-specific billing pathways.

Billing Tips

  • Ensure the prior authorization number is clearly linked to the claim submission to avoid administrative delays.
  • Since R110 is a unilateral code, if performing a bilateral procedure, ensure the second side is billed appropriately according to the Schedule of Benefits rules for bilateral surgical services.
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Provider Fee$472.15
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

Since Apr 2004, this fee has increased 0.0% vs 57.0% CPI inflation
Category

M. Integumentary System Surgical Procedures

Subcategory

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES

Service Type

Surgical

Code Classes

Integumentary System Surgical Procedures

Pre-Authorization Required
Sex Restriction

Female

R112R143R144

Surgical Assistant services are payable with 6 basic units plus time units.

Anaesthesia services are payable with 7 basic units plus time units.

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R110 – Reduction mammoplasty (female, to include nipple transplantation or grafting, if rendered) - unilateral | OHIP Fee Schedule | SnapBill MD