What is OHIP billing code R496?

R496 is "Removal of hemiarthroplasty - without replacement", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R496 pay?

The current OHIP fee for R496 is $242.25, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R496 to OHIP?

R496 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R496 claims against the Schedule of Benefits rules before submission.

What codes are related to R496?

Codes related to R496 in the Schedule of Benefits include R990.

All codes

R496

R496 – Removal of hemiarthroplasty - without replacement

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

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Represents a musculoskeletal surgical procedure. The specific details, indications, and procedural elements are not available as the source page was not provided. General rules for surgical procedures, assistant fees, and anaesthesia fees from the General Preamble apply. The fee for the surgeon is a flat rate, while fees for the assistant and anaesthesiologist are calculated based on basic units plus time-based units.

When to Use

Use R496 when performing a standalone removal of a hemiarthroplasty component (e.g., femoral head) without the immediate insertion of a new prosthesis.
Use this code for the explantation of a failed or infected hemiarthroplasty where the patient is being staged for a future reconstruction or where the prosthesis is being removed as a definitive treatment (e.g., Girdlestone procedure).

Common Pitfalls

Do not bill R496 if you are simultaneously performing a revision arthroplasty; in such cases, the removal is considered an integral part of the revision procedure code.
Avoid billing R496 for simple hardware removal (e.g., screws or plates) which fall under different musculoskeletal codes; this code is specific to hemiarthroplasty components.
Failure to document the specific clinical rationale for the removal without replacement can lead to audit scrutiny regarding the necessity of the procedure.

Billing Tips

Ensure the operative report clearly distinguishes the removal of the hemiarthroplasty from any other concurrent procedures to justify the use of this specific code.
If a second assistant is required, you must obtain pre-authorization and submit a formal letter of justification, as R496 does not carry automatic eligibility for a second assistant fee.

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Provider Fee$242.25

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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