What is OHIP billing code R616?

R616 is "Shoulder disarticulation", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R616 pay?

The current OHIP fee for R616 is $373.10, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R616 to OHIP?

R616 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R616 claims against the Schedule of Benefits rules before submission.

What codes are related to R616?

Codes related to R616 in the Schedule of Benefits include R617, R615.

All codes

R616

R616 – Shoulder disarticulation

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

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Shoulder disarticulation is a surgical procedure involving the amputation of the arm through the glenohumeral joint, separating the humerus from the scapula.

When to Use

Use R616 specifically for formal shoulder disarticulation where the humerus is separated from the scapula at the glenohumeral joint.
Do not use R616 for forequarter amputations (interscapulothoracic), which involve the removal of the scapula and clavicle; those require more extensive coding.
Use R616 when performing a definitive amputation for malignancy or severe trauma where a more distal amputation (e.g., R615) is not oncologically or surgically viable.

Common Pitfalls

Billing R616 alongside other musculoskeletal procedures on the same limb often triggers a 'multiple procedure' reduction; ensure the primary procedure is billed at 100% and secondary at 50% if applicable.
Attempting to bill a second surgical assistant for R616 will result in automatic rejection unless you obtain prior authorization and submit a letter of justification to the Ministry.
Confusing R616 with R617 (amputation of arm, other levels) leads to audit scrutiny; ensure the operative report explicitly confirms the glenohumeral joint disarticulation.

Billing Tips

If the procedure is performed for a qualifying trauma case, ensure the Injury Severity Score (ISS) is clearly documented in the chart to support the E420 trauma premium.
Always verify if the procedure qualifies for after-hours premiums (E409/E410) based on the actual start time of the surgery, not the time of patient arrival.

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Provider Fee$373.10

Surgical Assistant Fee$112.59

Anaesthetist Fee$139.41

Non-Anaesthetist Fee$139.41

Effective: April 1, 2025

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