R146 – Mastectomy - simple (male, benign)
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs a simple, unilateral mastectomy on a male patient for the treatment of benign breast disease. Conditions for this service include adolescent gynecomastia, gynecomastia secondary to endocrine or genetic disorders (e.g., Klinefelter's Syndrome), or chemotherapy. Prior approval from the Ministry is not required for this procedure. The service includes all standard surgical components. As a surgical procedure, this service includes the common and specific elements outlined in the Schedule of Benefits (see - for surgical assistant services and - for anaesthesia services). Note: Removal of male breast fat tissue by liposuction is not an insured service.
When to Use
- Use R146 for the surgical excision of breast tissue in male patients diagnosed with pathological gynecomastia, such as that resulting from Klinefelter's Syndrome or endocrine dysfunction.
- Use R146 for the treatment of persistent adolescent gynecomastia that has failed to resolve and requires surgical intervention.
- Use R146 for gynecomastia resulting from long-term chemotherapy or medication-induced hormonal changes.
Common Pitfalls
- Billing R146 for liposuction-only procedures will result in a rejection, as liposuction for fat removal is explicitly excluded from OHIP coverage.
- Attempting to bill R146 for cosmetic breast reduction in the absence of a documented medical diagnosis (e.g., endocrine disorder) is a common audit trigger.
- Billing R146 bilaterally is incorrect; this code is for a unilateral procedure, and you must use the appropriate bilateral indicator or submit as two separate claims if allowed by the Schedule.
Billing Tips
- Ensure the clinical record explicitly documents the underlying medical condition (e.g., Klinefelter's, hormonal imbalance) to support the 'benign breast disease' requirement.
- If performing the procedure on both sides, ensure you are billing the second side according to the multiple procedure rules in the General Preamble rather than assuming a flat double fee.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Male
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