R144 – Contralateral balancing augmentation mammoplasty
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Contralateral balancing augmentation mammoplasty. Note: 1. R143 and R144 are only eligible for payment when performed for post-mastectomy breast reconstruction. Prior authorization of payment from the Ministry of Health is not required. 2. R110 and R112 are not eligible for payment with R143 or R144. Commentary: 1. For reduction or augmentation mammoplasty performed for reasons other than a balancing procedure related to post-mastectomy breast reconstruction, see R110 and R112 respectively. Prior authorization of payment from the ministry is required. 2. See the applicable service for post-mastectomy breast reconstruction by myocutaneous flaps or free flaps.
When to Use
- Use R144 exclusively for contralateral breast augmentation to achieve symmetry following a post-mastectomy reconstruction.
- Use this code when the clinical intent is strictly balancing the reconstructed breast, distinguishing it from elective cosmetic augmentation which requires R112 and prior Ministry authorization.
Common Pitfalls
- Billing R144 alongside R110 or R112 will result in an automatic rejection as these codes are mutually exclusive.
- Submitting R144 for non-reconstructive cosmetic augmentation is a high-risk audit trigger, as this code is strictly reserved for post-mastectomy symmetry procedures.
Billing Tips
- Ensure the operative report clearly links the procedure to the preceding mastectomy reconstruction to justify the use of R144 over the cosmetic R112 code.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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