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R258

R258 – Osteotomy - middle proximal or metacarpal

OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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Osteotomy of the middle or proximal phalanx, or a metacarpal bone. This service is a reconstructive surgical procedure for bone deformities of the hand and wrist. It is listed as an alternative to R257 (osteotomy - terminal phalanx). For each additional osteotomy performed during the same operative session, the add-on code E591 may be claimed.

When to Use

  • Use R258 for corrective osteotomies of the metacarpal bones or the proximal/middle phalanges to address angular or rotational deformities.
  • Select R258 instead of R257 when the surgical site is proximal to the distal phalanx, as R257 is strictly reserved for terminal phalanx procedures.

Common Pitfalls

  • Claiming R258 for multiple bones without utilizing the E591 add-on code, which results in lost revenue for subsequent osteotomies performed in the same session.
  • Incorrectly billing R258 for distal phalanx procedures, which will trigger a rejection or audit risk as those must be billed under R257.

Billing Tips

  • Always append E591 for each additional osteotomy of a middle/proximal phalanx or metacarpal performed during the same operative session to maximize the claim value.
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Provider Fee$289.80
Surgical Assistant Fee$77.46
Anaesthetist Fee$111.72
Non-Anaesthetist Fee$111.72

Effective: April 1, 2026

Since Oct 2005, this fee has increased 50.0% vs 52.9% CPI inflation
Category

N. Musculoskeletal System Surgical Procedures

Subcategory

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES

Service Type

Surgical

Code Classes

Musculoskeletal System Surgical Procedures

R257E591

This procedure has 7 basic units for anaesthesia (Anae) and 6 basic units for an assistant (Asst).

Refer to the 'Surgical Assistants' Services' section starting on page for rules on calculating assistant fees, including after hours premiums such as E400B and E401B.

Refer to the 'Anaesthesiologists' Services' section starting on page for rules on calculating anaesthesia fees, including after hours premiums like E400C and E401C and applicable extra units based on patient factors (e.g. age, BMI, ASA status).

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R258 – Osteotomy - middle proximal or metacarpal | OHIP Fee Schedule | SnapBill MD