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E904
E904 – Posterior fossa
OHIP Surgical Assists Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on code. The fee for this service is added to the fee for the primary surgical procedure when the procedure involves the posterior fossa. The fee listed in the Schedule of Benefits is an addition of $241.00.
When to Use
- Use E904 as an add-on to primary neurosurgical procedures such as N218 (craniotomy) when the surgical approach or pathology is specifically localized within the posterior fossa.
- Apply this code when performing complex posterior fossa decompressions or tumor resections where the primary procedure code does not already account for the anatomical complexity of this region.
Common Pitfalls
- Billing E904 with procedures that already include posterior fossa access in their base fee structure, which will lead to automatic claim rejection or recovery upon audit.
- Attempting to bill E904 as a standalone service; it must be linked to a valid primary surgical procedure code on the same claim to be processed.
Billing Tips
- Ensure the primary procedure code is listed first on the claim, followed by E904, to allow the Ministry system to correctly identify the add-on relationship.
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