R094 – Simple excision - single lesion - other areas
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Simple excision of a single malignant lesion, including biopsy, located on areas other than the face or neck. Note: - 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. - When excision of benign, pre-malignant or malignant lesions are corrected by advancement, rotation, transposition, Z-plasty, flap or graft, claim appropriate benefit listed under Repair Section instead of this excision benefit.
When to Use
- Use R094 for the simple excision of a biopsy-proven malignant lesion (e.g., BCC or SCC) located on the trunk or extremities.
- Use this code when the defect is closed primarily with simple sutures, as opposed to complex repairs involving flaps or grafts which fall under the Repair Section.
Common Pitfalls
- Billing R094 for pre-malignant lesions like actinic keratosis will trigger a rejection or audit recovery, as these are not considered malignant for this fee.
- Failing to retain the pathology report in the patient's chart will result in a mandatory fee reduction to the lower benign excision rate during an audit.
- Billing R094 in conjunction with a flap or graft repair code is a billing error; you must claim the appropriate Repair Section code instead of the excision benefit.
Billing Tips
- If you perform a simple excision on the face or neck, use R093 instead of R094 to ensure the correct fee schedule is applied.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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.
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.
When excision of benign, pre-malignant or malignant lesions are corrected by advancement, rotation, transposition, Z-plasty, flap or graft, claim appropriate benefit listed under Repair Section instead of foregoing excision benefits.
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