R049 – Malignant lesion excision - two lesions (face or neck)
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service covers the simple excision of two malignant lesions, including the biopsy of each lesion, from the face or neck. A pre-malignant lesion is not considered a malignant lesion for payment purposes. If the repair of the excision site involves procedures such as an advancement flap, rotation flap, transposition flap, Z-plasty, or skin graft, the appropriate repair code should be claimed instead of R049. Payment for this service is contingent upon the pathologist's report being retained in the patient's medical record.
When to Use
- Use R049 when performing simple excisions of two distinct malignant lesions located on the face or neck during the same encounter.
- Use this code when the excision is closed primarily (e.g., simple sutures) rather than using complex repairs like flaps or grafts, which would trigger the use of codes in the Skin Flaps and Grafts section instead.
Common Pitfalls
- Billing R049 for pre-malignant lesions (e.g., actinic keratosis) will lead to recovery upon audit, as the code strictly requires a malignant diagnosis confirmed by pathology.
- Failing to retain the pathology report in the patient's chart is a common audit failure that results in the Ministry adjusting the payment to a significantly lower fee.
- Attempting to bill R049 alongside flap or graft codes for the same site is prohibited; if a flap is required for closure, you must bill the appropriate flap code instead of R049.
Billing Tips
- If performing the procedure in your office, ensure you add the E542 premium to capture the additional $12.65 fee allowed for non-hospital settings.
- Always ensure the pathology report explicitly confirms malignancy for both lesions to justify the use of the R049 fee over lower-valued benign lesion excision codes.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The pathologist's report must be retained in the patient's record or the amount payable will be adjusted to a lesser fee.
The amount payable for treatment of a malignant lesion will be adjusted to a lesser fee if the pathologist's report is not retained in the patient's record.
A pre-malignant lesion is not a malignant lesion for the purposes of payment.
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