What is OHIP billing code R415?

R415 is "Hip - with removal of loose body", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R415 pay?

The current OHIP fee for R415 is $301.60, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R415 to OHIP?

R415 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R415 claims against the Schedule of Benefits rules before submission.

What codes are related to R415?

Codes related to R415 in the Schedule of Benefits include R547, Z290, Z212, Z217, Z214, Z228, Z219, N188.

All codes

R415

R415 – Hip - with removal of loose body

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

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An open surgical procedure on the hip joint. This procedure is variously listed in the Schedule of Benefits as: - Arthrotomy, hip - with removal of loose body - Biopsy, joint - open - Incision and Drainage, joint All these descriptions correspond to the billing code R415. The service includes the surgeon's work for the procedure. Anaesthesia and assistant services are billed separately with corresponding base units.

When to Use

Use R415 when performing an open arthrotomy specifically to retrieve a loose body from the hip joint, as opposed to arthroscopic removal which is billed under different codes.
Use R415 for an open joint biopsy of the hip when no other definitive procedure is performed during the same session.
Use R415 for formal incision and drainage of the hip joint when the procedure involves an open surgical approach.

Common Pitfalls

Do not bill R415 in conjunction with arthroscopic procedures on the same joint; the open procedure code is intended for open surgical approaches only.
Avoid billing R415 as an 'add-on' to major hip reconstructions; if the removal of a loose body is incidental to a more comprehensive procedure like a total hip arthroplasty, it is considered part of the primary procedure and not separately billable.
Ensure the procedure is not confused with simple aspiration or injection codes, which carry significantly lower values and different clinical requirements.

Billing Tips

If the procedure is performed on a trauma patient meeting the specific Injury Severity Score (ISS) thresholds, apply the E420 trauma premium to increase the fee by 50%.
When performing bilateral procedures during the same anaesthetic, ensure the major procedure is identified to correctly determine the base units for anaesthesia and surgical assistance.

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Provider Fee$301.60

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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