What is OHIP billing code R926?

R926 is "Interrupted aortic arch", an OHIP Radiology code from the Ontario Schedule of Benefits (Physician Services).

How much does R926 pay?

The current OHIP fee for R926 is $1516.70, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill R926 to OHIP?

R926 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates R926 claims against the Schedule of Benefits rules before submission.

All codes

R926

R926 – Interrupted aortic arch

OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits

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A surgical procedure for the repair of an interrupted aortic arch. This service is a complex cardiovascular surgical procedure typically performed to correct a congenital heart defect.

When to Use

Use R926 for the definitive surgical repair of a congenital interrupted aortic arch, typically involving end-to-end anastomosis or patch augmentation.
Select R926 when the procedure is the primary corrective intervention for the interruption, distinguishing it from palliative shunt procedures or isolated coarctation repairs.

Common Pitfalls

Attempting to bill a second surgical assistant without prior authorization; unlike some complex cardiovascular codes, R926 does not have automatic approval for a second assistant.
Incorrectly stacking E420 with after-hours premiums (E409A/E410A); the Schedule of Benefits explicitly excludes the simultaneous payment of trauma premiums and after-hours/special visit premiums.
Failing to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, which is a common trigger for post-payment audit recovery.

Billing Tips

Always verify the patient's exact age at the time of the procedure to ensure the correct age premium (ranging from 10% to 30%) is applied, as these are significant percentage increases on the $1516.70 base fee.
Ensure the non-elective status is clearly supported by the clinical record if billing E409A or E410A, as these premiums are strictly reserved for procedures that cannot be deferred to elective scheduling.

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Provider Fee$1,516.70

Surgical Assistant Fee$225.18

Anaesthetist Fee$433.72

Non-Anaesthetist Fee$433.72

Effective: April 1, 2025

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