What is OHIP billing code R446?

R446 is "Overlapping 5th toe reconstruction", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R446 pay?

The current OHIP fee for R446 is $136.35, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R446 to OHIP?

R446 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R446 claims against the Schedule of Benefits rules before submission.

What codes are related to R446?

Codes related to R446 in the Schedule of Benefits include R363, R321, R259, R276, E596, R277, R337, R338.

All codes

R446

R446 – Overlapping 5th toe reconstruction

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

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A surgical procedure for the correction of an overlapping 5th toe. This procedure is listed in the Musculoskeletal System section of the Schedule of Benefits under Foot and Ankle reconstruction. The service has 6 base units for an assistant (R446B) and 7 base units for anaesthesia (R446C).

When to Use

Use R446 for the surgical correction of a symptomatic overlapping 5th toe, such as a soft tissue release or bony realignment procedure.
Use R446 when the procedure is performed as a standalone reconstruction, distinct from more complex forefoot reconstructions like R363 or R321.

Common Pitfalls

Billing R446 in addition to other forefoot procedures on the same foot can trigger a 'duplicate' or 'included' service rejection; ensure the procedure is distinct and not part of a global surgical package for a larger reconstruction.
Failing to document the specific anatomical deformity (e.g., varus rotation, dorsal contracture) can lead to audit scrutiny regarding the medical necessity of the reconstruction.

Billing Tips

If performing bilateral R446, append the appropriate bilateral modifier (e.g., 'BI') to the claim to ensure the second procedure is processed at the correct percentage of the fee.
Always verify if the procedure is performed in a hospital or ambulatory surgical center, as the facility setting may impact the global surgical fee rules and the eligibility of associated anaesthesia codes.

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Provider Fee$136.35

Specialist Fee$0.00

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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