What is OHIP billing code R861?

R861 is "Per-obturator ilio-femoral graft - with prosthetic graft", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R861 pay?

The current OHIP fee for R861 is $876.85, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R861 to OHIP?

R861 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R861 claims against the Schedule of Benefits rules before submission.

What codes are related to R861?

Codes related to R861 in the Schedule of Benefits include R860.

All codes

R861

R861 – Per-obturator ilio-femoral graft - with prosthetic graft

OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits

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Per-obturator ilio-femoral graft with prosthetic graft is a surgical procedure to restore blood flow to the lower limb. It involves creating a bypass from the iliac artery to the femoral artery by routing a synthetic graft through the obturator foramen, typically used when the normal groin pathway is compromised (e.g., by infection, radiation, or scarring).

When to Use

Use R861 when performing an ilio-femoral bypass via the obturator foramen specifically to avoid a hostile groin field, such as in cases of prior radiation, extensive scarring, or active infection.
Select R861 when the standard anatomical pathway for an ilio-femoral graft is inaccessible or unsafe, necessitating the obturator route for graft placement.

Common Pitfalls

Billing R861 in conjunction with other standard ilio-femoral bypass codes (e.g., R860) is considered unbundling; ensure the procedure is coded as a single, distinct surgical event.
Failing to document the clinical rationale for the obturator route (e.g., 'hostile groin') can lead to audit scrutiny regarding the necessity of this specific approach over standard bypass techniques.

Billing Tips

Ensure the operative report explicitly details the graft routing through the obturator foramen to support the use of this specific code over more general vascular bypass codes.
Verify that all applicable after-hours premiums (E409, E410) are applied if the procedure meets the timing criteria, as these are frequently missed on high-value surgical claims.

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Provider Fee$876.85

Surgical Assistant Fee$125.10

Anaesthetist Fee$154.90

Non-Anaesthetist Fee$154.90

Effective: April 1, 2025

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