What is OHIP billing code R278?

R278 is "Maxilla, with exenteration of orbit and skin graft", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R278 pay?

The current OHIP fee for R278 is $532.95, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R278 to OHIP?

R278 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R278 claims against the Schedule of Benefits rules before submission.

What codes are related to R278?

Codes related to R278 in the Schedule of Benefits include R272, R279, R280, R284, R428, R433, R531, R532.

All codes

R278

R278 – Maxilla, with exenteration of orbit and skin graft

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

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This is a major surgical procedure involving the complete or partial removal of the maxilla (upper jaw bone), the exenteration (removal) of the contents of the eye socket, and closure with a skin graft. This procedure is typically performed for extensive tumours. The fee listed is for the primary surgeon (suffix 'A'). When an assistant or anaesthetist is required, their services are billed using the same code with suffix 'B' or 'C' respectively, and their fees are calculated based on a combination of basic and time units as specified in the and sections of the Schedule.

When to Use

Use R278 when performing a radical maxillectomy that specifically includes orbital exenteration and subsequent skin grafting for malignant neoplasms.
Select R278 over R279 (Maxilla, resection of) when the surgical plan explicitly mandates the removal of the orbital contents, as R278 is the comprehensive code for this combined procedure.

Common Pitfalls

Billing R278 alongside separate codes for orbital exenteration or skin grafting is considered unbundling; the fee for R278 is intended to be comprehensive for the combined procedure.
Failure to document the specific extent of the maxillectomy and the necessity of the orbital exenteration can lead to audit recovery, as this is a high-value, complex procedure.

Billing Tips

Ensure the surgical report clearly details the involvement of the orbit to justify the use of R278 over less extensive maxillary resection codes.
If the procedure is performed on an emergency basis, ensure the appropriate after-hours or night premium (E409 or E410) is applied to the primary surgeon's fee.

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Provider Fee$532.95

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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