R111 – Partial mastectomy or wedge resection
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Partial mastectomy or wedge resection is an excisional procedure for the treatment of breast disease. It involves the removal of a portion of the breast tissue, often for conditions like carcinoma or extensive fibrocystic disease. The fee for R111 is comprehensive and includes a biopsy if one is performed concurrently. As stated in the General Preamble on page , the phrase 'with or without' means that the biopsy is included in the fee for the service when performed.
When to Use
- Use R111 for the excision of a breast lesion or tissue segment where the primary intent is therapeutic treatment of breast disease, such as a lumpectomy for carcinoma.
- Use R111 when performing a wedge resection for extensive fibrocystic disease, as the fee is comprehensive and includes any concurrent biopsy.
Common Pitfalls
- Do not bill a separate biopsy code concurrently with R111, as the General Preamble (GP6) mandates that biopsies are included in the R111 fee.
- Avoid billing E505 (limited axillary node sampling) if you are also billing Z427 (sentinel node biopsy) for the same patient, as these are mutually exclusive.
Billing Tips
- Always append the appropriate add-on code (E525 for wire/seed localization, E546 for axillary dissection, or E505 for limited sampling) to R111 on the same claim to ensure full compensation for the surgical scope.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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