What is OHIP billing code R394?

R394 is "Cranial vault reshaping - anterior or posterior half", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R394 pay?

The current OHIP fee for R394 is $1525.30, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R394 to OHIP?

R394 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R394 claims against the Schedule of Benefits rules before submission.

What codes are related to R394?

Codes related to R394 in the Schedule of Benefits include R390, R653, R654, E973, R655, E974, R378, R656.

All codes

R394

R394 – Cranial vault reshaping - anterior or posterior half

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

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This surgical procedure involves the reshaping of the anterior or posterior half of the cranial vault. The fee for this service, as indicated by the asterisk on page , includes the harvesting and grafting of bone or cartilage grafts. The service is classified under Musculoskeletal System Surgical Procedures for the skull and mandible. As with all insured services, it includes the common elements outlined in the General Preamble (, ). The service can be claimed by the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C). The assistant's fee is calculated based on 10 basic units plus time units (). The anaesthetist's fee is calculated based on 20 basic units plus time units ().

When to Use

Use R394 for the surgical reshaping of either the anterior or posterior half of the cranial vault, specifically when the procedure includes the harvesting and grafting of bone or cartilage.
Select R394 for craniosynostosis correction involving a single vault segment, distinguishing it from more extensive procedures like R393 which covers the entire vault.

Common Pitfalls

Do not bill separately for bone or cartilage harvesting, as the fee for R394 is inclusive of these components per the code description.
Avoid billing R394 in conjunction with other cranial vault procedures unless they involve distinct, non-overlapping anatomical sites, as this may trigger a claim rejection for unbundling.

Billing Tips

Ensure the surgical report clearly specifies whether the anterior or posterior half was reshaped to justify the use of R394 over other cranial vault codes.
If the patient is under 16 years of age, verify that the age-based fee premium is applied to the surgeon, assistant, and anaesthetist claims to ensure the correct percentage increase.

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Provider Fee$1,525.30

Surgical Assistant Fee$125.10

Anaesthetist Fee$309.80

Non-Anaesthetist Fee$309.80

Effective: April 1, 2025

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