R527 – Muscle transplant - pectoralis major
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure involving the transplantation of the pectoralis major muscle. The statement regarding a second assistant's service for R527 without prior authorization is incorrect.
When to Use
- Use R527 specifically for the surgical transplantation of the pectoralis major muscle in female patients.
- Select R527 when the procedure is performed as a primary musculoskeletal reconstruction rather than as part of a broader, multi-component plastic surgery code.
Common Pitfalls
- Submitting R527 for male patients will result in an automatic rejection due to the specific sex restriction defined for this code.
- Attempting to bill a second assistant for R527 without explicit prior authorization will lead to claim denial, as the Schedule of Benefits does not automatically support dual assistance for this procedure.
Billing Tips
- Ensure the operative report clearly details the pectoralis major muscle mobilization and transfer to support the medical necessity of the procedure during a potential audit.
- Verify the patient's age at the time of the procedure to correctly apply the appropriate age-based fee premium (e.g., under 16 years) to maximize the procedural fee.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
All insured services must be documented in appropriate records establishing that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
Female
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