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R438
R438 – Humeral Prosthesis
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R438 is a surgical arthroplasty procedure for the insertion of a humeral prosthesis. - Assistant fee is based on 6 base units. - Anaesthesia fee is based on 10 base units. - When performed as a revision of a previous prosthesis, premium E564 (add 35%) applies. - This procedure is eligible for payment for a second surgical assistant without special authorization as per .
When to Use
- Use R438 for the primary insertion of a humeral prosthesis in cases of complex humeral head fractures or advanced glenohumeral arthritis.
- Use R438 for the surgical replacement of the humeral component when the procedure is classified as a revision, ensuring the addition of E564.
Common Pitfalls
- Failing to append E564 when performing a revision of a previously placed humeral prosthesis, resulting in a 35% underpayment.
- Attempting to bill R438 alongside R694, which is explicitly excluded from eligibility for the E564 revision premium.
Billing Tips
- Submit the second surgical assistant claim concurrently with R438, as it is pre-authorized and does not require a letter of justification.
- Ensure the Injury Severity Score (ISS) is documented in the medical record if claiming the E420 trauma premium for R438 within 24 hours of injury.
Provider Fee$676.90
Surgical Assistant Fee$77.46
Anaesthetist Fee$159.60
Non-Anaesthetist Fee$159.60
Effective: April 1, 2026
Since Apr 2004, this fee has increased 50.7% vs 58.5% 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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