R646 – Reconstruction mandible - complete (Bilateral)
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Bilateral, complete reconstruction of the mandible with bone grafts and/or plate or prosthesis. The asterisk (*) on 'bone grafts' in the Schedule of Benefits indicates that the harvesting of bone grafts may be claimed separately. Assistant Fee: The fee for a surgical assistant is calculated by adding 6 basic units to the time units for the duration of the assistance. The total units are multiplied by the surgical assistant unit fee. Refer to - for detailed calculation rules. Anaesthesia Fee: The fee for anaesthesia is calculated by adding 15 basic units to the time units for the duration of the anaesthetic. The total units are multiplied by the anaesthesiologist unit fee. Refer to - for detailed calculation rules.
When to Use
- Use R646 for complete bilateral mandibular reconstruction involving both bone grafting and internal fixation hardware (plates or prostheses).
- Select R646 instead of R645 when the surgical scope involves the entire mandible bilaterally rather than a unilateral or partial reconstruction.
Common Pitfalls
- Failing to claim the bone graft harvesting separately; the asterisk in the code description explicitly permits additional billing for the graft procurement.
- Attempting to bill R646 in conjunction with R334 or R335 for the same anatomical site, which constitutes unbundling and will lead to claim rejection.
Billing Tips
- Ensure the operative report clearly details the bilateral nature of the reconstruction and the specific materials used to support the 'complete' classification of the procedure.
- If the procedure is performed as an emergency or after hours, ensure the appropriate premium (E409 or E410) is linked to the claim to maximize the procedural fee.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
If the procedure is performed by a Medical Trainee, the medical record must identify the Supervising Physician, the Medical Trainee and their level of training, a description of the service, patient consent for supervision, and be reviewed and signed by the Supervising Physician.
The note on page states: 'For Z253 to Z262, services described as harvesting and/or use of homogenous bone grafts may be claimed in addition. See page for the appropriate listing(s).' While this note is not directly attached to R646, the description for R646 includes an asterisk on 'bone grafts*', implying a similar rule applies.
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