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L867
L867 – Surgical Pathology, Unlisted specimens
OHIP Dermatology Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
When to Use
- Use L867 for complex or rare specimens that do not meet the specific criteria for levels L861 through L866, such as specialized tissue biopsies requiring unique processing protocols.
- Apply this code for non-standard surgical specimens where the complexity of the gross or microscopic examination is not explicitly defined in the Schedule of Benefits.
Common Pitfalls
- Billing L867 for a specimen that clearly fits the criteria of L861-L866 will trigger a rejection or audit, as the Ministry expects the use of the most specific code available.
- Failing to provide sufficient clinical context in the pathology report can lead to claim denials, as the Ministry may flag the use of an 'unlisted' code as an attempt to bypass standard fee schedules.
Billing Tips
- Ensure the pathology report explicitly justifies why the specimen does not fall under L861-L866 to support the use of the unlisted code during a potential audit.
Provider Fee$47.95
Effective: April 1, 2026
Category
J. Diagnostic and Therapeutic Procedures
Subcategory
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Service Type
Laboratory
Code Classes
Diagnostic and Therapeutic Procedures
Referral RequiredFrom: Physician, NursePractitioner, DentalSurgeon, OralMaxillofacialSurgeon, Midwife
All insured services must be documented in appropriate records. The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary. See Appendix G of the Schedule for full details.
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