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E525

E525Localization with mammographic wire or radioactive seeds

OHIP Surgical Assists Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

This is an add-on code to be claimed in addition to the fee for the primary excision procedure. It is payable for R107 (Tumour or tissue for diagnostic biopsy and/or treatment) or R111 (Partial mastectomy or wedge resection for treatment of breast disease) when the procedure is performed after localization with a mammographic wire or radioactive seeds.

When to Use

  • Claim E525 when performing an excisional biopsy (R107) for a non-palpable breast lesion that required pre-operative needle localization.
  • Claim E525 when performing a partial mastectomy or lumpectomy (R111) where radioactive seed localization (RSL) was utilized to guide the surgical resection.

Common Pitfalls

  • Attempting to claim E525 as a standalone service; it is strictly an add-on code and will be rejected if not billed with an eligible primary procedure like R107 or R111.
  • Billing E525 for palpation-guided excisions where no wire or radioactive seed localization was performed, which constitutes an audit risk for inappropriate billing.

Billing Tips

  • Ensure the primary procedure (R107 or R111) is listed first on the claim, followed by E525, to ensure the system correctly identifies the add-on relationship.
  • If the procedure qualifies for after-hours premiums (E409 or E410), apply the percentage increase to the primary procedure fee, but note that E525 itself is a fixed add-on fee.
Provider Fee$48.05

Effective: April 1, 2025

Category

M. Integumentary System Surgical Procedures

Subcategory

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES

Service Type

Procedure

Code Classes

Integumentary System Surgical Procedures

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