R495 – Fasciotomy for compartment syndrome
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure from the Musculoskeletal System section of the Schedule of Benefits. The fee listed is for the surgeon (suffix A). Surgical assistance (suffix B) and anaesthesia (suffix C) services are also payable and are calculated based on a system of basic units plus time-based units as defined in the General Preamble (, ). Various premiums for age, after-hours services, and trauma may also apply.
When to Use
- Use R495 for the emergent surgical release of fascial compartments when clinical diagnosis of compartment syndrome is confirmed.
- Use this code for the initial decompression procedure; do not use it for subsequent debridement or secondary wound closure, which are billed separately.
Common Pitfalls
- Billing Z783 on the same day as R495 is a common rejection; secondary wound closure is not included in the R495 fee and must be billed as a separate procedure.
- Failing to document the Injury Severity Score (ISS) in the medical record will result in the automatic rejection of the E420 trauma premium.
- Assuming a second surgical assistant is automatically covered; R495 is not on the pre-authorized list (GP90), so you must obtain prior approval from a medical consultant.
Billing Tips
- Ensure the start time of the procedure is accurately recorded to correctly calculate time-based units for assistants (suffix B) and anaesthesiologists (suffix C) according to GP85 and GP92.
- When claiming after-hours premiums (E409/E410), ensure the procedure start time is clearly documented to justify the specific percentage increase applied to the R495 base fee.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Payment for surgical assistant (suffix B) and anaesthesiologist (suffix C) services are based on a system of basic units plus time units. The fee is calculated by multiplying the total units by the respective unit fee. - **Surgical Assistant (R495B):** The fee is the sum of basic units and time units, multiplied by the assistant unit fee of $12.91. Time units are 1 unit per 15 minutes for the first hour, 2 units per 15 minutes after the first hour up to and including the first 1.75 hours, and 3 units per 15 minutes after 1.75 hours. See - for full details. - **Anaesthesiologist (R495C):** The fee is the sum of basic units and time units, multiplied by the anaesthesiologist unit fee of $15.96. Time units are 1 unit per 15 minutes for the first hour, 2 units per 15 minutes after the first hour up to 1.5 hours, and 3 units per 15 minutes after 1.5 hours. See - for full details.
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