What is OHIP billing code R594?

R594 is "Rotator cuff repair - complex", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R594 pay?

The current OHIP fee for R594 is $498.30, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R594 to OHIP?

R594 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R594 claims against the Schedule of Benefits rules before submission.

What codes are related to R594?

Codes related to R594 in the Schedule of Benefits include R593.

All codes

R594

R594 – Rotator cuff repair - complex

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

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Rotator cuff repair - complex (includes implantation into bone, and as required, acromioplasty, excision of coraco-acromial ligament, subacromial bursa and excision of distal clavicle). As per , the service of a second assistant for this procedure is payable without requiring prior authorization by a medical consultant.

When to Use

Use R594 for complex rotator cuff repairs that involve bone implantation, specifically when the procedure also necessitates acromioplasty, subacromial bursa excision, or distal clavicle excision.
Choose R594 over R593 when the surgical complexity exceeds a standard repair, specifically when the inclusion of the listed secondary procedures (e.g., distal clavicle excision) is required to complete the repair.

Common Pitfalls

Do not bill R594 in conjunction with codes for acromioplasty or distal clavicle excision as separate procedures, as these are considered inclusive to the R594 fee.
Avoid billing R594 for simple tendon repairs that do not involve bone implantation, as this may trigger an audit for over-billing the complexity of the service.

Billing Tips

Ensure your operative report explicitly details the bone implantation and any secondary procedures performed (e.g., acromioplasty) to justify the 'complex' designation of R594.
When a second assistant is required, bill the second assistant's service alongside R594, as this code is specifically designated as eligible for second assistant payment without prior authorization.

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Provider Fee$498.30

Surgical Assistant Fee$75.06

Anaesthetist Fee$154.90

Non-Anaesthetist Fee$154.90

Effective: April 1, 2025

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