What are the billing rules for E495A?

With R687, E494 and E495 need, unless the Ministry gave prior approval: Kellgren-Lawrence grade below 3 on standing knee x-rays within the last 12 months, and unstable chondral pathology or a meniscal tear with mechanical symptoms that failed at least 6 months of active non-surgical treatment (N45). Not payable with E496 for the same meniscus (N47). Meniscal trimming alone does not qualify (N47).

What is E495A often billed with?

R687 or R699 knee arthroscopy set-up (N45). E494 debridement of degenerative cartilage (N46).

Why is E495A rejected?

ADF: OHIP describes this as 'Corresponding procedure invalid, omitted or paid at zero': the add-on was billed without a paid R687 or R699 on the same claim. ADH: OHIP describes this as 'Cannot be billed together': E495 and E496 on the same meniscus (N47).

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Billing code

E495A — Arthroscopic meniscectomy – knee

Q: What is OHIP billing code E495A?

Arthroscopic add-on for partial or total meniscectomy for a symptomatic meniscal tear.

Arthroscopic knee meniscectomy

Add to knee arthroscopy (R687 or R699) for partial or total meniscectomy for a symptomatic meniscal tear.

Watch for: Meniscal trimming alone doesn't qualify, and it isn't payable with E496 for the same meniscus.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$240.45	$0.00	$0.00	$0.00	$0.00

Code: E495A
Description: Arthroscopic meniscectomy – knee
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Apr 1, 2025
Termination date: No end date

Explanation

Updated October 26, 2026

Arthroscopic add-on for partial or total meniscectomy for a symptomatic meniscal tear.

What it covers

E495 is partial or total meniscectomy for a symptomatic meniscal tear, billed as an add-on to the knee arthroscopy set-up (R687 or R699) (N45, N46).

Trimming of a meniscus is not E495 (N47). Open meniscectomy is R429 (N47).

Billing rules

With R687, E494 and E495 need, unless the Ministry gave prior approval: Kellgren-Lawrence grade below 3 on standing knee x-rays within the last 12 months, and unstable chondral pathology or a meniscal tear with mechanical symptoms that failed at least 6 months of active non-surgical treatment (N45).
Not payable with E496 for the same meniscus (N47).
Meniscal trimming alone does not qualify (N47).
Pre- and post-procedure arthroscopic photos kept in the chart are recommended when E495 is claimed with R687 (N46).

Often billed with

R687 or R699 knee arthroscopy set-up (N45).
E494 debridement of degenerative cartilage (N46).

Common rejections

ADF: OHIP describes this as 'Corresponding procedure invalid, omitted or paid at zero': the add-on was billed without a paid R687 or R699 on the same claim.
ADH: OHIP describes this as 'Cannot be billed together': E495 and E496 on the same meniscus (N47).

Related codes: R687, R699, E494, E496, R429

Source: Schedule of Benefits (July 1, 2026), Musculoskeletal System Surgical Procedures, Knee, page N46; arthroscopy payment rules N45.

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