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L827
L827 – Interpretation of Carcinoembryonic Antigen (Cea)
OHIP Dermatology Code — Laboratory Medicine · Schedule of Benefits
This service is for the professional interpretation of a carcinoembryonic antigen (CEA) test result.
When to Use
- Use L827 when you are actively managing a patient with a confirmed diagnosis of colorectal cancer and are interpreting the CEA level as part of their surveillance or treatment monitoring.
- Use this code when the CEA result is abnormal and requires a documented clinical decision or change in management plan based on the interpretation.
Common Pitfalls
- Billing L827 for routine screening in asymptomatic patients is considered an ineligible service and will be rejected or clawed back during an audit.
- Submitting L827 alongside a visit fee (e.g., A007) for the same patient on the same day is often flagged as an unbundled service if the interpretation is considered part of the office visit assessment.
Billing Tips
- Ensure the clinical indication for the CEA test is clearly linked to the interpretation to justify the medical necessity of the professional service fee.
- Do not bill L827 if the CEA test was performed as part of a general laboratory investigation; it must be specifically interpreted in the context of oncological follow-up.
Provider Fee$5.30
Specialist Fee$0.00
Surgical Assistant Fee$0.00
Anaesthetist Fee$0.00
Non-Anaesthetist Fee$0.00
Effective: April 1, 2025
Category
Diagnostic and Therapeutic Procedures
Subcategory
Laboratory Medicine
Service Type
Diagnostic
Code Classes
Diagnostic and Therapeutic Procedures
As per the Health Insurance Act, all insured services must be documented in appropriate records. The medical record must establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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