All codes
R054
R054 – Pilonidal cyst - simple excision or marsupialization, if patient's BMI greater than 40
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Pilonidal cyst - simple excision or marsupialization, if patient's BMI greater than 40
When to Use
- Use R054 specifically when performing a simple excision or marsupialization of a pilonidal cyst on a patient with a documented BMI greater than 40.
- Use this code instead of R035 or R036 when the patient's obesity significantly increases the technical complexity of the surgical procedure.
Common Pitfalls
- Submitting R054 without explicit documentation of the patient's height and weight or calculated BMI in the operative report will lead to audit recovery.
- Billing R054 for a standard pilonidal cyst excision on a patient with a BMI of 40 or less is an incorrect use of the code and will be rejected or clawed back.
Billing Tips
- Ensure the operative note explicitly states the patient's BMI to justify the use of this specific code over the standard R035 or R036 codes.
Provider Fee$273.90
Surgical Assistant Fee$77.46
Anaesthetist Fee$95.76
Non-Anaesthetist Fee$95.76
Effective: April 1, 2026
Category
M. Integumentary System Surgical Procedures
Subcategory
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record 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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