E542 – Procedure performed outside hospital
OHIP Surgical Assists Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
The E542 premium is an add-on fee payable when certain minor surgical and diagnostic procedures are performed outside of a hospital. This includes but is not limited to:
- Removal of IUD (G552)
- Excision of skin lesions (`Z156, Z162, R048)
- Wound debridement (Z080-Z085)
- Laceration repair (Z154, etc.)
- Nail procedures (Z128, etc.)
- Biopsies (Z141, Z501)
- Paracentesis (Z590, etc.)
- Excision of a chalazion (Z874`)
When to Use
- Use E542 when performing a minor surgical procedure like an excision (e.g., Z156) or biopsy (e.g., Z501) in your office setting rather than a hospital facility.
- Apply E542 when performing a laceration repair (e.g., Z154) in a clinic environment to compensate for the overhead of maintaining a sterile procedure room.
- Use E542 alongside G552 when performing an IUD removal in the office to capture the premium for non-hospital surgical services.
Common Pitfalls
- Claiming E542 for procedures performed within a hospital setting, which will result in a rejection as this premium is strictly for office-based procedures.
- Attempting to bill E542 with non-surgical codes; it is only eligible for specific surgical and diagnostic codes listed in the Schedule of Benefits.
- Billing E542 multiple times for a single visit if multiple procedures are performed; it is a per-visit premium, not a per-procedure premium.
Billing Tips
- Ensure E542 is submitted on the same claim as the primary surgical procedure code to ensure the system recognizes the service location context.
- Verify that the procedure code used is explicitly listed as an add-on eligible code for E542 in the Schedule of Benefits to avoid automatic claim adjustments.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Premium
Other Premiums (including After Hours Procedure Premiums)
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