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E125
E125 – Laser retinopexy for Retinopathy of Prematurity or retinoblastoma
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
This code is for a surgical procedure to perform laser retinopexy on one eye for the treatment of Retinopathy of Prematurity (ROP). ROP is a disease that primarily affects premature infants, involving abnormal blood vessel development in the retina which can lead to retinal detachment and blindness if not treated.
When to Use
- Use E125 for the primary surgical treatment of threshold or pre-threshold Retinopathy of Prematurity (ROP) via laser retinopexy in one eye.
- Use E125 when performing laser retinopexy for retinoblastoma as specified in the code description.
Common Pitfalls
- Billing E125 bilaterally on a single claim line will result in rejection; you must submit separate lines for each eye, typically using the appropriate eye modifiers (e.g., LT/RT).
- Failure to apply the correct age-based premium (either 30% for <30 days or 25% for <1 year) is a common missed revenue opportunity for this procedure.
Billing Tips
- Always verify the patient's age at the time of the procedure to ensure the correct age premium is appended to the E125 fee.
- If performing bilateral procedures, ensure the claim reflects the correct surgical rules for multiple procedures under the same anaesthetic to avoid payment adjustment errors.
Provider Fee$750.00
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
Y. Ocular and Aural Surgical Procedures
Subcategory
OCULAR SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Ocular and Aural Surgical Procedures
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