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S003
S003 – Excision of lesion of oral cavity and pharynx - 2 to 4 cms, inclusive
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
S003 represents the surgical excision of a lesion, measuring 2 to 4 cms inclusive, located within the oral cavity or pharynx. The fee listed is for the surgeon (suffix A). Fees are also payable for an assistant (suffix B) and anaesthetist (suffix C), calculated based on basic and time units as defined in the Schedule of Benefits. An additional fee (E542) may be claimed when this procedure is performed outside of a hospital setting.
When to Use
- Use S003 for the surgical excision of a benign or malignant lesion in the oral cavity or pharynx that measures between 2.0 cm and 4.0 cm inclusive.
- Select S003 when the lesion size exceeds the threshold for S002 but remains below the 4.0 cm limit for S004.
Common Pitfalls
- Billing S003 alongside a diagnostic biopsy code like Z502 for the same lesion is considered unbundling and will be rejected.
- Failure to document the precise size of the lesion in the operative report often leads to audit recovery if the size is not clearly between 2 and 4 cm.
- Claiming S003 for a lesion smaller than 2 cm is a common billing error; use S002 for smaller lesions to avoid rejection.
Billing Tips
- If performing this procedure in your office rather than a hospital, ensure you append E542 to the claim to receive the additional premium payment.
Provider Fee$0.00
Specialist Fee$354.50
Surgical Assistant Fee$75.06
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
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