What is OHIP billing code R260?

R260 is "Osteotomy - humerus", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R260 pay?

The current OHIP fee for R260 is $559.25, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R260 to OHIP?

R260 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R260 claims against the Schedule of Benefits rules before submission.

All codes

R260

R260 – Osteotomy - humerus

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

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R260 is a surgical procedure listed in the Musculoskeletal System section of the Schedule of Benefits. The fee is payable to the physician who performs the procedure (using suffix A). Payment for surgical assistant (suffix B) and anaesthetist (suffix C) services are also listed and calculated by adding basic units (as listed in the Schedule) and time units, then multiplying by the respective unit fee. This service is eligible for several premiums, including age-based fee premiums for patients under 16 years of age (see :), after-hours premiums for non-elective procedures (see :), and the trauma premium for severely injured patients (see :). The use of a second assistant requires special authorization from a medical consultant (see :).

When to Use

Use R260 for a formal humeral osteotomy procedure, such as a corrective osteotomy for malunion or deformity, rather than simple fracture fixation codes.
Select R260 when performing a planned surgical division of the humerus, distinguishing it from R258 (Open reduction of humeral fracture) which involves different clinical indications.

Common Pitfalls

Billing R260 alongside fracture reduction codes (e.g., R258) for the same site is a common audit trigger; ensure the procedure is distinct and documented as a separate surgical intent.
Failure to document the Injury Severity Score (ISS) in the chart when claiming the E420 trauma premium will result in a clawback during post-payment audits.
Attempting to bill a second surgical assistant without prior written authorization from a medical consultant will lead to automatic rejection of the second assistant's claim.

Billing Tips

Ensure the start time of the procedure is clearly recorded in the operative report to justify the application of after-hours (E409A/E410A) or night premiums.
When treating pediatric patients, verify the exact age in days or years to apply the correct age-based fee premium (e.g., AGE_PREMIUM_U16Y) to the R260 base fee.

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Provider Fee$559.25

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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