R120

PDF page 576 / M26

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
OPERATIONS OF THE BREAST
                                                                        Asst       Surg       Anae
          a.extensive undermining for local advancement flaps >10cm to obliterate inferior or lateral
            excess flap deformities associated with simple mastectomies, or
          b.modified M-plasty or fishtail closure
       Note:
       Skin grafts are not eligible for payment in addition to R117.
     [Commentary:
     For patients who have been approved by OHIP for mastectomy related to sex-reassignment
     surgery, the following fee codes may apply for mastectomy depending on the technique:
     1.R108 - Mastectomy simple + R120 for nipple preservation and grafting.]
# R109 Mastectomy, radical or modified radical (with or without biopsy) 6      780.00      7
     [Commentary:
     Skin grafts are eligible for payment in addition to R109.]
    Mastectomy - male (benign)
      Unilateral - for treatment of adolescent gynecomastia, gynecomastia secondary to endocrine or
      genetic disorders (e.g. Klinefelter's Syndrome) or chemotherapy. Prior approval is not required.
      Removal of male breast fat tissue by liposuction is not an insured service.
# R146 - simple ................................................................................. 6 177.50 7
# R147 - subcutaneous with nipple preservation ..............................                     6 273.95 7
    Mastectomy - male
      Unilateral - for treatment of pathological male breast disease (with or without biopsy), e.g.
      carcinoma
# R148 - simple ................................................................................. 6 311.95 7
# R149 - subcutaneous with nipple preservation ..............................                     6 273.95 7
# E505     - with limited axillary node sampling, to R148 or R149 add                               178.05
    Oncoplastic Breast Surgery
# R102 Level 1 oncoplastic breast conserving lumpectomy or partial
           mastectomy for malignancy................................................             6 350.00 7
# R158 Level 2 oncoplastic breast conserving lumpectomy or partial
           mastectomy for malignancy................................................             6 547.45 7
# E505    - with limited axillary node sampling, to R102, R158 or
             R159 .......................................................................... add   178.05
# E525    - after localization with mammographic wire or radioactive
             seeds, to R102, R158 or R159 .................................. add                    48.05
# E546     - with axillary node dissection up to the level of the axillary
             vein, to R102, R158 or R159 ...........................................               388.75
# R159 Level 3 oncoplastic breast conserving lumpectomy or partial
           mastectomy for malignancy................................................             6 701.15 7
      Payment rules:
      1.R102 is only eligible for payment when
         a.resected breast volume is <= 15% of ipsilateral breast parenchyma, and
         b.the operative report documents dual plane undermining and lumpectomy defect closure
      2.R102 includes nipple undermining, nipple-areolar complex elevation or centralization, skin
        resection and glandular advancement if performed.

PDF page 578 / M28

Post-mastectomy breast reconstruction
  # R119 Breast mound creation by prosthesis as sole procedure........                                         6         350.00          7
  # R118 Breast skin reconstruction by local flaps or grafts, includes
           Wise pattern skin flaps and de-epithelialized skin flaps .....                                      6         405.60          6
  # E529   - with breast mound creation by prosthesis, to R118 ... add                                                   102.45
  # R156 Breast mound creation by insertion of tissue expander,
           includes creation of submuscular pocket ...........................                                 6         425.00          6
  # E513   - breast mound creation by soft tissue, includes flap
             insetting and shaping for autogenous reconstruction, to
             R118, R125, R064, R008 or R155 ............................. add                                            297.50
  # E514   - immediate breast reconstruction following mastectomy, to
             R125, R064, R156, R008, R118, or R155 ................. add                                                 200.00
                                          Note:
                                          1.Z132 is not eligible for payment with R156.
                                          2.E513 is not eligible for payment with E529.
                                          3.E514 is only eligible for payment if post-mastectomy breast reconstruction is performed
                                            immediately following mastectomy during the same anaesthesia.
  # R114 Revision of breast mound .......................................................                     6          230.30          7
  # R120 Nipple-areola reconstruction by grafts and/or flaps ................                                 6          300.00          7
  # R142 Nipple-areola tattooing - unilateral..........................................                       nil        175.00          nil
  # R143 Contralateral balancing mastopexy or reduction, to include
           nipple transplantation or grafting, if rendered.....................                                6         472.15          6
  # R144 Contralateral balancing augmentation mammoplasty.............       6        350.00       6
       Note:
       1.R143 and R144 are only eligible for payment when performed for post-mastectomy breast
         reconstruction. Prior authorization of payment from the Ministry of Health is not required.
                                          2.R110 and R112 are not eligible for payment with R143 or R144.
                                          [Commentary:
                                          1.For reduction or augmentation mammoplasty performed for reasons other than a balancing
                                            procedure related to post-mastectomy breast reconstruction, see R110 and R112
                                            respectively. Prior authorization of payment from the ministry is required.
                                          2.See the applicable service for post-mastectomy breast reconstruction by myocutaneous
                                            flaps or free flaps.]
      Reduction mammoplasty and augmentation mammoplasty (other than post-mastectomy
      breast reconstruction)
  # R110 Reduction mammoplasty (female, to include nipple
            transplantation or grafting, if rendered) - unilateral ............ 6 472.15 7
  # R112 Augmentation mammoplasty - unilateral ................................ 6 350.00 7

Master, record 4375. Record Layout PDF, page 1.

R12020260401999999990000300000000000774600000000000000000111720000001117200

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.