What is OHIP billing code R353?

R353 is "Scapulopexy congenital elevation", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R353 pay?

The current OHIP fee for R353 is $385.15, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R353 to OHIP?

R353 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R353 claims against the Schedule of Benefits rules before submission.

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R353

R353 – Scapulopexy congenital elevation

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

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This is a surgical procedure for scapulopexy congenital elevation, listed under the 'Musculoskeletal System Surgical Procedures' section, specifically within 'Reconstruction' and 'Muscles/soft tissues'. General rules for surgical procedures, including billing for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) apply. Additional premiums for age, after-hours services, and trauma may be applicable.

When to Use

Use R353 specifically for the surgical correction of Sprengel’s deformity (congenital elevation of the scapula) involving scapulopexy.
This code is the primary procedure code for the musculoskeletal reconstruction of the scapular position; do not use general orthopedic reconstruction codes if R353 is applicable.

Common Pitfalls

Failing to apply the mandatory age-based premiums (e.g., AGE_PREMIUM_LT16Y) for pediatric patients, which are frequently applicable given the congenital nature of the condition.
Attempting to bill R353 in conjunction with other musculoskeletal procedures without ensuring the 'multiple procedure' rule is followed, which may result in a reduction of the secondary procedure fee.
Omitting the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium for acute post-traumatic scapular displacement.

Billing Tips

Always verify the patient's age at the time of the procedure to ensure the correct percentage-based age premium is appended to the claim, as this is a high-volume pediatric surgery code.
If the procedure is performed after hours, ensure the claim includes the appropriate E409 or E410 premium, but note that these cannot be combined with the E420 trauma premium on the same claim.

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Provider Fee$385.15

Surgical Assistant Fee$75.06

Anaesthetist Fee$92.94

Non-Anaesthetist Fee$92.94

Effective: April 1, 2025

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