R143 – Contralateral balancing mastopexy or reduction
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for contralateral balancing mastopexy or reduction, which includes nipple transplantation or grafting if rendered. Per a note on page , this service is only eligible for payment when performed for post-mastectomy breast reconstruction. Prior authorization of payment from the Ministry of Health is not required for this service. This procedure is not eligible for payment with R110 (Reduction mammoplasty) or R112 (Augmentation mammoplasty). For reconstruction using myocutaneous or free flaps, refer to the applicable service codes.
When to Use
- Use R143 for a contralateral mastopexy or reduction performed specifically to achieve symmetry following a post-mastectomy breast reconstruction.
- Use R143 when nipple transplantation or grafting is required as part of the balancing procedure on the non-reconstructed breast.
Common Pitfalls
- Billing R143 for cosmetic reduction or mastopexy; this code is strictly restricted to post-mastectomy reconstruction cases.
- Attempting to bill R143 in conjunction with R110 or R112; these codes are mutually exclusive and will result in claim rejection.
- Failing to clearly document the clinical necessity of the balancing procedure in relation to the primary post-mastectomy reconstruction.
Billing Tips
- Ensure the claim explicitly links the R143 procedure to the post-mastectomy reconstruction context to avoid audit triggers.
- Remember that R143 includes any necessary nipple transplantation or grafting, so do not bill these components separately.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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