What is OHIP billing code R133?

R133 is "Transplantation of free island bone flap with microvascular anastomosis(es) and bone fixation", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R133 pay?

The current OHIP fee for R133 is $1028.20, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R133 to OHIP?

R133 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R133 claims against the Schedule of Benefits rules before submission.

What codes are related to R133?

Codes related to R133 in the Schedule of Benefits include R131, R132, R124, R128, R129, R123, R130, R134.

All codes

R133

R133 – Transplantation of free island bone flap with microvascular anastomosis(es) and bone fixation

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

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Transplantation of a free island bone flap with microvascular anastomosis(es) and bone fixation. This service is a component of microsurgical free tissue transfer for reconstruction. This procedure is typically performed in conjunction with flap elevation (e.g., R131) and recipient site preparation (e.g., R132 or R124).

When to Use

Use R133 specifically for the microvascular anastomosis and bone fixation phase of a free bone flap transfer, such as a fibula free flap.
Use this code when the procedure involves the transfer of bone tissue requiring revascularization, distinct from soft-tissue-only free flaps like R128 or R129.
Apply this code in conjunction with R131 for the harvest/elevation of the bone flap and R132 for the recipient site preparation.

Common Pitfalls

Billing R133 without documenting the specific microvascular anastomosis performed, which is a mandatory requirement for this code.
Attempting to bill R133 as a standalone procedure; it is intended as a component of a larger reconstructive surgery and must be linked to the associated flap elevation and site preparation codes.
Failure to clearly distinguish the bone fixation component from general fracture fixation codes, which are not appropriate for free tissue transfer.

Billing Tips

Ensure the operative report explicitly details the microvascular anastomosis (arterial and venous) to support the R133 claim during potential audits.
When performing complex multi-stage reconstructions, verify that R133 is billed alongside the appropriate recipient site preparation (e.g., R132) to ensure the full surgical scope is captured.

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Provider Fee$1,028.20

Surgical Assistant Fee$125.10

Anaesthetist Fee$154.90

Non-Anaesthetist Fee$154.90

Effective: April 1, 2025

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