What is OHIP billing code E528?

E528 is "Additional expander, different incision", an OHIP Surgical Assists code from the Ontario Schedule of Benefits (Physician Services).

How much does E528 pay?

The current OHIP fee for E528 is $258.50, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill E528 to OHIP?

E528 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates E528 claims against the Schedule of Benefits rules before submission.

What codes are related to E528?

Codes related to E528 in the Schedule of Benefits include Z132, E527, Z094, Z095, Z137, E541, Z138.

All codes

E528

E528 – Additional expander, different incision

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

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The E528 fee is payable in addition to `Z132 (Insertion of tissue expander) when an additional expander is inserted using a different incision. This procedure is subject to the same notes as Z132`, meaning it is not eligible for payment for post-mastectomy reconstruction and may require prior authorization from the Ministry of Health for certain conditions (e.g., for scars of legs).

When to Use

Use E528 when placing a second tissue expander in a separate anatomical site during the same operative session as the primary Z132 insertion.
Use E528 for reconstructive procedures involving multiple expanders for non-breast related conditions, such as severe scarring on the lower extremities, provided Ministry of Health authorization is obtained.

Common Pitfalls

Billing E528 as a standalone code will result in an automatic rejection as it is strictly an add-on to Z132.
Attempting to use E528 for post-mastectomy breast reconstruction is a common audit trigger, as both Z132 and its add-ons are ineligible for this indication.
Failure to obtain and document prior Ministry of Health authorization for non-standard indications (e.g., leg scars) will lead to claim clawbacks during post-payment review.

Billing Tips

Ensure the operative report explicitly details the use of a separate incision for the second expander to justify the E528 claim in the event of a Ministry audit.
Always link the E528 claim to the same diagnostic code used for the primary Z132 procedure to maintain consistency in your submission.

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Provider Fee$258.50

Effective: April 1, 2025

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