What is OHIP billing code R136?

R136 is "Transplantation of free island skin and bone flap with microvascular anastomosis(es) and bone fixation", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R136 pay?

The current OHIP fee for R136 is $1048.60, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R136 to OHIP?

R136 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R136 claims against the Schedule of Benefits rules before submission.

What codes are related to R136?

Codes related to R136 in the Schedule of Benefits include R134, R135, R140, R025.

All codes

R136

R136 – Transplantation of free island skin and 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 free island skin and bone flap with microvascular anastomosis(es) and bone fixation. This complex reconstructive surgery involves transferring a composite tissue flap, including skin and bone, from a donor site to a recipient site, and re-establishing its blood supply through microvascular surgery. This code is eligible for surgeon (A suffix), assistant (B suffix), and anaesthesia (C suffix) services. A second assistant's services are payable without special authorization as per .

When to Use

Use R136 for composite free tissue transfers involving both skin and bone that require microvascular anastomosis, such as a fibula free flap for mandibular reconstruction.
Select R136 when the procedure necessitates both the microvascular revascularization of the flap and formal bone fixation (e.g., plating or screw fixation) at the recipient site.

Common Pitfalls

Do not bill R136 in combination with R134 or R135 for the same site, as these codes are mutually exclusive for the same anatomical defect reconstruction.
Failure to document the specific microvascular anastomosis and the method of bone fixation can lead to recovery during an audit, as these are mandatory components of the R136 definition.

Billing Tips

Since R136 allows for a second assistant without prior authorization, ensure the operative report clearly outlines the distinct roles of both assistants to justify the additional billing.
If the procedure is performed as an emergency trauma case, remember to document the Injury Severity Score (ISS) to support the E420 trauma premium, which is calculated on the R136 procedural fee.

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Provider Fee$1,048.60

Surgical Assistant Fee$125.10

Anaesthetist Fee$154.90

Non-Anaesthetist Fee$154.90

Effective: April 1, 2025

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