R990 – Independent Consideration for unlisted surgical procedures
OHIP Radiology Code — SURGICAL PREAMBLE · Schedule of Benefits
The R990 fee code is used for unusual but generally accepted surgical procedures which are not listed specifically in the Schedule of Benefits. It should not be used for non-major variations of procedures that are already listed. As this service is payable on an Independent Consideration (IC) basis, claims must be submitted with a supporting letter that: - Explains the amount of the fee claimed. - Includes an appropriate operative or consultation report. - Provides a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
When to Use
- Use for novel, evidence-based surgical techniques that have not yet been assigned a specific fee code in the Schedule of Benefits.
- Use when a surgery is abandoned after the procedure has commenced, as this is specifically recognized as an IC event under R990.
- Use for highly complex, multi-stage reconstructions that combine elements of multiple listed procedures where no single code accurately reflects the total work.
Common Pitfalls
- Do not use R990 for minor variations of existing procedures; if a listed code exists, you must use it even if the work involved is slightly higher than average.
- Failure to include a detailed operative report and a comparative analysis against existing codes will result in automatic rejection or a request for further information.
- Avoid using R990 for procedures that are simply 'unlisted' because they are considered experimental or not medically necessary by OHIP standards.
Billing Tips
- When justifying the fee, explicitly reference the dollar value of a comparable procedure (e.g., 'This procedure is 50% more complex than S123, therefore I am claiming 1.5x the value of S123').
- Ensure the supporting letter is submitted concurrently with the claim to avoid processing delays, as IC claims require manual review by a medical consultant.
Effective: January 1, 2019
SP. Surgical Preamble
SURGICAL PREAMBLE
Surgical
Diagnostic and Therapeutic Procedures
A supporting letter explaining the amount of the fee claimed.
An appropriate operative or consultation report.
A comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
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