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R523
R523 – Muscle - complex
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure R523 is claimable by the operating surgeon using suffix A. Surgical assistance may be claimed with suffix B, and anaesthesia services with suffix C. Payment for assistant and anaesthesia services are calculated based on basic units plus time units as defined in the Schedule of Benefits. General payment rules, including those for multiple procedures, after-hours work, and trauma, apply.
When to Use
- Use R523 for complex musculoskeletal surgical procedures that do not have a more specific anatomical code in the Schedule of Benefits.
- Select this code when performing extensive soft tissue or muscle repairs that exceed the complexity of standard minor musculoskeletal procedures.
Common Pitfalls
- Claiming a second surgical assistant without prior authorization from a medical consultant, as R523 is not on the pre-approved list for multiple assistants.
- Failing to document the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium alongside this procedure.
Billing Tips
- Ensure the surgical start time is clearly documented to support after-hours premiums (E409, E410) or anaesthesia-specific after-hours premiums (E400C, E401C).
Provider Fee$484.35
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
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