R153 – Major plastic surgery procedure
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Major plastic surgery procedure, as classified by the responsible specialist. This service is part of a series of codes (R150-R154) for plastic surgical procedures, categorized by complexity. Requirements: - A descriptive operative report must be submitted with the claim for professional assessment. Restrictions: - Not eligible for payment for the repair of any laceration(s). - Not eligible for payment to physicians in General and Family Practice (00) or Emergency Medicine (12) specialties. Billing Information: - Surgeon (A): Fee-for-service. - Assistant (B): Calculated fee based on 6 base units plus time units. See - for calculation rules. - Anaesthetist (C): Calculated fee based on 7 base units plus time units. See - for calculation rules.
When to Use
- Use R153 for complex reconstructive plastic surgery procedures that do not have a specific, dedicated fee code in the Schedule of Benefits.
- Use this code for staged procedures where the complexity is categorized by the specialist as 'major' and requires a detailed operative report for assessment.
- Use R153 when performing non-laceration related integumentary reconstructions that exceed the complexity of minor or intermediate codes like R151 or R152.
Common Pitfalls
- Submitting R153 for the repair of any laceration will result in automatic rejection; use the specific laceration repair codes instead.
- Failure to attach a detailed operative report to the claim will lead to a rejection or a request for manual review, as R153 is an assessed service.
- Attempting to bill R153 as a General Practitioner or Emergency Medicine physician is strictly prohibited and will be rejected by the system.
Billing Tips
- Ensure the operative report explicitly justifies the 'major' classification to avoid down-coding by the Ministry during the assessment process.
- Always verify if the procedure qualifies for age-based premiums or after-hours premiums (E409/E410) to maximize the claim value, as these are compatible with R153.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Descriptive details of procedure (e.g. operative report) should be submitted with claims for codes R150 - R154 for professional assessment.
R150, R151, R152, R153, and R154 are not eligible for payment for the repair of any laceration(s). See repair of laceration services in the Integumentary System Surgical Procedures section of this Schedule.
R150, R151, R152, R153, and R154 are not eligible for payment to physicians in the following specialties: General and Family Practice (00) and Emergency Medicine (12).
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