R535 – Mandibular osteotomies for retrognathia, any technique - advancement - greater than 20 mm
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is for a mandibular osteotomy for retrognathia, using any technique, where the mandible is advanced greater than 20 mm. This is a major surgical procedure listed in the Musculoskeletal System section of the Schedule. The service includes all common elements (, ) and specific elements of a surgical procedure (, ), including pre-operative and post-operative care. Payment for assistant and anaesthetist services are calculated based on a system of base units plus time units. The add-on code E588 may be claimed in addition for apertognathia or laterognathia.
When to Use
- Use R535 specifically for mandibular advancement procedures where the measured surgical movement exceeds 20 mm.
- Use R535 when performing major mandibular osteotomies for retrognathia correction that meet the specific distance threshold, distinguishing it from lesser advancements covered by other codes.
Common Pitfalls
- Claiming R535 for advancements of 20 mm or less, which may lead to audit recovery if the clinical documentation does not support the >20 mm requirement.
- Failing to include the add-on code E588 on the same claim when the procedure specifically addresses concurrent apertognathia or laterognathia.
Billing Tips
- Ensure the operative report explicitly documents the magnitude of the mandibular advancement to justify the use of R535 over lower-tier osteotomy codes.
- Always verify if the patient meets the criteria for age-based surgical premiums or trauma premiums (E420) to maximize the claim value on the same submission.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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