What is OHIP billing code R593?

R593 is "Rotator cuff repair - simple, end-to-end or side-to-side", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R593 pay?

The current OHIP fee for R593 is $345.35, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R593 to OHIP?

R593 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R593 claims against the Schedule of Benefits rules before submission.

What codes are related to R593?

Codes related to R593 in the Schedule of Benefits include E645, M111, M112, M117, M134, M142, P042, P051.

All codes

R593

R593 – Rotator cuff repair - simple, end-to-end or side-to-side

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

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Rotator cuff repair - simple, end-to-end or side-to-side (includes acromioplasty, excision of coraco-acromial ligament and subacromial bursa).

When to Use

Use R593 for simple, primary rotator cuff repairs involving end-to-end or side-to-side suturing techniques.
Use this code when the procedure includes the mandatory bundled components of acromioplasty, excision of the coraco-acromial ligament, and subacromial bursa excision.
Select R593 for standard open or arthroscopic-assisted repairs that do not involve complex tissue transfer or extensive augmentation.

Common Pitfalls

Do not bill separately for acromioplasty or subacromial decompression, as these are explicitly included in the R593 fee.
Avoid using R593 for complex repairs requiring graft augmentation or extensive mobilization, which may be more appropriately coded under higher-complexity musculoskeletal surgical codes.
Ensure the operative report clearly describes the repair technique; billing R593 for a repair that lacks the required bundled components (e.g., no acromioplasty) can trigger audit scrutiny.

Billing Tips

If a second surgical assistant is required for the procedure, it is eligible for payment without prior authorization, calculated at the same rate as the first assistant.
Always verify if the procedure qualifies for age-based premiums (e.g., AGE_PREMIUM_LT16) or after-hours premiums (E409/E410) if the case meets the specific non-elective or emergency criteria.

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Provider Fee$345.35

Surgical Assistant Fee$75.06

Anaesthetist Fee$154.90

Non-Anaesthetist Fee$154.90

Effective: April 1, 2025

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