Z096 – Lipoma - 5 to 10 cm
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Z096 is a fee code for a surgical procedure, 'Lipoma - 5 to 10 cm', as described on page of the Schedule. Billing for this service must follow the general rules outlined in the General Preamble for surgical procedures. This includes the application of suffixes 'A' for the surgeon, 'B' for the assistant, and 'C' for the anaesthetist. Fees for assistants and anaesthetists are calculated based on basic units (specific to the procedure) and time units. Various premiums for after-hours services, specific patient age groups, and complex cases like trauma may also apply. A hospital admission assessment by the surgeon is generally not payable separately unless it constitutes the major pre-operative visit where the decision to operate was made (). For procedures prefixed with a 'Z', an admission assessment is deemed a specific re-assessment if the surgical specialist assessed the patient prior to admission for the same illness ().
When to Use
- Use Z096 for the excision of a lipoma measuring between 5 cm and 10 cm in its greatest dimension.
- Use this code for surgical removal in a hospital setting; if performed in a clinic or office, ensure you also append the E542 premium.
Common Pitfalls
- Billing Z096 for a lipoma smaller than 5 cm, which should be billed under lower-value codes like Z095, leading to potential audit recovery.
- Failing to include the 'A' suffix, which causes the claim to be rejected as the system requires a surgical suffix for all 'Z' series codes.
- Attempting to bill a separate consultation or assessment fee on the same day as the procedure, which is generally disallowed under GP23 and GP40 rules.
Billing Tips
- Always measure the lesion pre-operatively and document the size in the operative report to justify the use of Z096 over smaller excision codes.
- If the procedure is performed in an office or clinic setting, remember to add the E542 code to capture the $12.65 premium.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary 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.
This is a surgical procedure and must be claimed with suffix 'A' by the operating surgeon.
Assistant at surgery (suffix 'B') is payable based on a calculation of basic units plus time units. The fee for assistant services for Z096 is listed as $84.84. After-hours premiums E400B (50%) and E401B (75%) may apply. Special visit premiums may also be applicable (, ).
Anaesthesia service (suffix 'C') is payable based on a calculation of basic units plus time units. The fee for anaesthesia for Z096 is listed as $105.06. After-hours premiums E400C (50%) and E401C (75%) may apply. Various extra units for patient conditions (e.g., age, BMI, ASA status) may be added (). Special visit premiums may also be applicable ().
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.