R112 – Augmentation mammoplasty - unilateral
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Augmentation mammoplasty - unilateral is a surgical procedure for breast augmentation. This service is intended for cases not related to post-mastectomy breast reconstruction. As per the commentary on page , this procedure requires prior authorization of payment from the Ministry of Health. It should not be confused with R144, which is for contralateral balancing augmentation mammoplasty following a mastectomy and does not require prior authorization.
When to Use
- Use R112 for unilateral breast augmentation procedures that are not related to post-mastectomy breast reconstruction.
- Use this code for congenital breast asymmetry correction where prior Ministry authorization has been successfully obtained.
Common Pitfalls
- Billing R112 without explicit prior authorization from the Ministry of Health will result in automatic claim rejection.
- Confusing R112 with R144; R144 is specifically for contralateral balancing following a mastectomy and does not require the same prior authorization as R112.
- Attempting to bill R112 in conjunction with R143 or R144, which is strictly prohibited by the Schedule of Benefits.
Billing Tips
- Ensure the Ministry's prior authorization letter is on file and the authorization number is referenced in your claim submission to prevent processing delays.
- Verify that the procedure is not for post-mastectomy reconstruction, as those cases fall under different billing categories like R144.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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