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R280
R280 – Mandible excision
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of the mandible. This is a surgical procedure and is eligible for fees for the surgeon (A suffix), assistant (B suffix), and anaesthetist (C suffix). The fee for the assistant is based on 6 base units plus time units. The fee for the anaesthetist is based on 7 base units plus time units. Various premiums may apply, including those for age, after-hours services, and trauma.
When to Use
- Use R280 for the formal excision of the mandible, typically for malignancy or severe osteomyelitis, rather than minor debridement or biopsy procedures.
- Select R280 when the procedure involves the removal of a significant portion of the mandibular bone, distinguishing it from simple tooth extraction or alveolar ridge procedures.
Common Pitfalls
- Do not bill R280 in conjunction with after-hours premiums (E400/E401 series) if you are also claiming the E420 Trauma Premium, as these are mutually exclusive.
- Failure to document the Injury Severity Score (ISS) in the medical record when claiming the E420 Trauma Premium will result in a clawback during audit.
- Attempting to bill a standard hospital admission assessment on the same day as R280 will be rejected; only the major pre-operative assessment is eligible.
Billing Tips
- Ensure the surgical assistant and anaesthetist claims are submitted with the correct suffix (B and C respectively) to trigger the appropriate base and time unit calculations.
- If a second surgical assistant is required due to the complexity of the mandible excision, you must obtain prior authorization and submit a formal letter of justification to avoid automatic rejection.
Provider Fee$353.10
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Since Apr 2004, this fee has increased 0.0% vs 57.0% CPI inflation
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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