What is OHIP billing code R516?

R516 is "Release patellar retinaculum", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R516 pay?

The current OHIP fee for R516 is $161.45, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R516 to OHIP?

R516 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R516 claims against the Schedule of Benefits rules before submission.

What codes are related to R516?

Codes related to R516 in the Schedule of Benefits include R584, E050, R589, R587, R571, E049, Z237, Z238.

All codes

R516

R516 – Release patellar retinaculum

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

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Release of the patellar retinaculum is a surgical procedure listed under the Musculoskeletal System section of the OHIP Schedule of Benefits. It is categorized under 'Knee' and sub-categorized under 'Muscles/Tendons'. This service is eligible for surgical assistant services (R516B) and anaesthesiologist services (R516C), with base units of 6 and 7 respectively as per .

When to Use

Use R516 for an isolated lateral patellar retinacular release performed to address patellar maltracking or lateral tilt.
Use R516 when the procedure is performed as a standalone surgical intervention, distinct from more extensive procedures like a formal tibial tubercle osteotomy (R584) or patellar stabilization (R589).

Common Pitfalls

Billing R516 in conjunction with other major knee reconstructions (e.g., R589) often triggers a 'multiple procedure' reduction; ensure you are not unbundling components of a more comprehensive surgery.
Failing to document the specific indication for the release can lead to audit scrutiny, as this code is frequently reviewed for medical necessity in the context of chronic patellofemoral pain syndrome.

Billing Tips

If the retinacular release is performed as part of a larger arthroscopic procedure, verify if the Schedule of Benefits considers it an integral component of the primary code to avoid duplicate billing rejections.
Ensure the surgical report explicitly describes the release of the lateral retinaculum to support the use of R516 if the claim is flagged for manual review.

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Provider Fee$161.45

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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