What is OHIP billing code R538?

R538 is "LeFort I intrusion - in one segment", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R538 pay?

The current OHIP fee for R538 is $1059.35, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R538 to OHIP?

R538 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R538 claims against the Schedule of Benefits rules before submission.

What codes are related to R538?

Codes related to R538 in the Schedule of Benefits include E963, E964, R379, R567, R580.

All codes

R538

R538 – LeFort I intrusion - in one segment

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

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Performs a LeFort I intrusion osteotomy in one segment. This is an orthognathic surgical procedure on the skull and mandible. This procedure can be extended to two segments by adding E963 or to three segments by adding E964.

When to Use

Use R538 as the primary base code when performing a LeFort I intrusion osteotomy limited to a single segment.
Use R538 in conjunction with E963 when the surgical plan requires a LeFort I intrusion across two distinct segments.
Use R538 in conjunction with E964 when the surgical plan requires a LeFort I intrusion across three distinct segments in a hospital setting.

Common Pitfalls

Billing E963 or E964 without R538 on the same claim will result in automatic rejection as these are strictly add-on codes.
Attempting to bill R538 for multi-segment procedures without the appropriate add-on code (E963 or E964) constitutes under-billing and inaccurate procedural reporting.
Failure to document the specific number of segments in the operative report can lead to recovery of funds during an audit if the billed add-on code is challenged.

Billing Tips

Always ensure the add-on code (E963 or E964) is submitted on the same claim as R538 to trigger the correct total procedural payment.
Verify that the surgical setting meets the requirements for E964, as this add-on is specifically restricted to hospital-based procedures.

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Provider Fee$1,059.35

Surgical Assistant Fee$125.10

Anaesthetist Fee$309.80

Non-Anaesthetist Fee$309.80

Effective: April 1, 2025

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