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Dermatology OHIP billing codes
Dermatology assessments including e-assessments, skin biopsy and lesion removal, intralesional and light therapy, Mohs surgery and nail procedures.
49 codes in 9 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 02 is in the full Dermatology listing.
Consultations & assessments — office
- A025Complex psoriasis or complex dermatitisConsultation—
- A020Complex Dermatology Assessment—
- A021Complex dermatology assessmentAdvanced Dermatology Consultation—
- A023Specific AssessmentSpecific Assessment - Dermatology—
- A024Complex psoriasis or complex dermatitisPartial assessment (Dermatology)—
- A026Complex psoriasis or complex dermatitisRepeat consultation - Dermatology—
- A027Consultation in Association with Special Visit to a Hospital in-Patient, Long-Term Care in-Patient or Emergency Department PatientConsultation in association with special visit (Hospital/LTC/ED)—
E-assessments
- U025Initial E-AssessmentThe first e-assessment performed by a dermatologist for a specific patient and diagnosis, requested by a primary care physician or nurse practitioner, requiring review of relevant data and a written opinion.—
- U026Follow-Up E-AssessmentA limited electronic or telephonic assessment by a Dermatologist for follow-up on a patient previously seen for the same diagnosis, initiated by a request from a primary care provider.—
- U021Complex psoriasis or complex dermatitisA brief e-assessment rendered by a specialist who reviews all relevant information submitted and provides an answer to a primary care physician's or nurse practitioner's specific clinical question.—
- U023Complex psoriasis or complex dermatitisFirst e-assessment by a specialist following an initial e-assessment or consultation, requested by a primary care physician or nurse practitioner for the same diagnosis, requiring review of relevant data and provision of management advice.—
Hospital in-patient
- C025Dermatology consultation - non-emergency hospital in-patient—
- C020Complex dermatology assessmentComplex dermatology assessment (in-patient)—
- C024Specific re-assessmentSpecific re-assessment - Dermatology—
- C022Subsequent visit - first five weeksSubsequent visit - first five weeks (per visit)—
- C027Subsequent visit - sixth to thirteenth week- sixth to thirteenth week (maximum 3 per patient per week) (per visit) (Dermatology)—
- C029Subsequent visit - after thirteenth week—
- C023Subsequent visits - Nursing home or home for the agedSpecific assessment - Dermatology - Hospital In-patient—
Biopsy
Lesion treatment & excision
- Z117Chemical and/or cryotherapy treatment of skin lesionsA procedure involving chemical and/or cryotherapy treatment for one or more skin lesions. This service is limited to one per patient per day and includes any associated paring or debulking.$12.75
- Z119Cryotherapy treatment of at least 5 pre-malignant actinic keratosis lesionsA surgical procedure with a fee of $32.80. Assistant and anaesthetist fees are not separately payable. Age-based premiums for patients under 16 are applicable. Specific procedural details are not available in the provided context.$31.80
- R018Curettage, electrodesiccation or cryosurgery - single lesionCurettage, electrodesiccation, or cryosurgery for a single malignant lesion on the face or neck. Payment is conditional on retaining the pathologist's report in the patient's record.$75.10
- Z162Nevus - single lesionSurgical removal by excision and suture of a single nevus lesion. This service is not insured if performed for purely cosmetic purposes.$21.90
- Z163Nevus - two lesionsSurgical removal of two nevi by excision and suture. Add-on code <billingCode>E542</billingCode> is payable when performed outside of a hospital. This service is not insured if performed for purely cosmetic purposes.$29.05
- Z164Nevus - three or more lesionsSurgical removal by excision and suture of three or more nevi. This service is only insured when medically necessary due to clinical suspicion of disease or malignancy, and not for cosmetic purposes.$48.50
- Z122Cyst, haemangioma, lipoma - single lesion - face or neck - local anaestheticsingle lesion$42.20
- Z125Cyst, haemangioma, lipoma - single lesion - other areasA surgical procedure identified by a 'Z' prefix. General rules for surgical procedures, including assistant and anaesthesia services, apply. Specific details for `<billingCode>Z125</billingCode>` are not provided in the context.$35.05
- R160Simple excision of pre-malignant lesion - Face or NeckSimple excision of a single pre-malignant lesion on the face or neck.$58.30
- R161Simple excision of two pre-malignant lesions (Face or Neck)Simple excision of two pre-malignant lesions (Face or Neck).$95.75
- R163Simple excision of pre-malignant lesion - Other AreasSimple excision of pre-malignant lesion - Other Areas - single lesion$47.75
- R164Simple excision of two pre-malignant lesions (other areas)A surgical procedure on the integumentary system. Payment is available for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C). Additional premiums may apply for services after hours, for trauma cases, or based on patient age.$78.65
- R048Simple excision of single malignant lesion - face or neckSimple excision of a single malignant lesion on the face or neck. Payment requires a pathologist's report to be retained in the patient's record.$100.95
- R049Malignant lesion excision - two lesions (face or neck)Surgical procedure for the simple excision of two malignant lesions, including biopsy of each, located on the face or neck. Payment is conditional on a pathologist's report being retained.$152.50
- R040Simple excision of two malignant lesions (other areas)Surgical service for the simple excision of two malignant lesions located on areas of the body other than the face or neck. Payment requires retention of a pathologist's report.$104.85
- R041Malignant lesion excision - three or more lesionsSurgical service for the simple excision of three or more malignant lesions on areas of the body other than the face or neck. This fee includes the biopsy of each lesion.$209.70
Intralesional, light & patch testing
- G375Intralesional infiltration - one or two lesionsThis service covers the intralesional infiltration of one or two lesions. This procedure is intended to be billed in addition to a patient assessment.$10.50
- G377Intralesional infiltration - 3 or more lesionsPayable for the intralesional infiltration of three or more lesions. This service is an add-on to a visit and is not insured for the treatment of acne with corticosteroids.$15.80
- G470Ultraviolet light therapyUltraviolet light therapy, such as general UV or PUVA, for dermatological conditions. It is limited to once per day and can be delegated in an office setting but is not payable in hospital or designated physiotherapy clinics.$7.85
- G206Patch testmaximum of 90 per patient, per year (per test)$2.39
Mohs & laser
- R081Mohs micrographic surgery - initial cutInitial cut and debulking for Mohs micrographic surgery on a histologically confirmed cutaneous malignancy that meets specific criteria for size, location, or risk. Includes simple closure by undermining and advancement flaps.$315.45
- R051Laser surgery on Group 1 - 4, pre-malignant and malignant lesionsThis service is for laser surgery performed on Group 1-4 pre-malignant and malignant lesions. Payment is determined by Independent Consideration (IC) and requires submission of supporting documentation.—
Nails
- Z128Simple, partial or complete, nail plate excision requiring anaesthesia - oneA simple, partial, or complete excision of one finger or toe-nail plate that requires anaesthesia. An additional fee (<billingCode>E542</billingCode>) is applicable if the procedure is performed outside of a hospital setting.$36.30
- Z129Simple, partial or complete, nail plate excision requiring anaesthesia - multipleSurgical excision of multiple fingernails or toenails, partial or complete, requiring anaesthesia.$39.20
- Z130Radical nail bed destruction - oneRadical surgical excision of a single fingernail or toenail, including the destruction of the nail bed. Assistant services are not payable. An additional fee is applicable when performed outside a hospital.$68.75
- Z131Radical nail bed destruction - multipleSurgical procedure for the radical excision of multiple fingernails or toenails, including the destruction of the nail bed, typically requiring anaesthesia.$90.70
Long-term care
- W025Consultation - Non-Emergency Long-Term Care In-Patient ServicesA consultation for a patient in a long-term care institution, such as a nursing home or chronic care hospital, requested by a referring physician, nurse practitioner, or dental surgeon. This service requires a written request and a report back to the referring practitioner.—
- W023Dermatology subsequent visit - nursing home or home for the aged - first 2 per monthRepresents one of the first two subsequent visits per month by a specialist in Dermatology to a patient in a nursing home or home for the aged. This service has a limit of two visits per patient, per physician, per month.—
- W028Additional subsequent visits (maximum 3 per patient per month) - Nursing home or home for the aged - DermatologyAn additional subsequent visit, per visit, for a patient in a nursing home or home for the aged by a dermatologist. This service is limited to a maximum of three per patient per month.—
How to use this dermatology code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to dermatology (specialty 02) — its own consultation and assessment codes, in-patient visits, premiums and the diagnostics or procedures that make up most of a day — sectioned the way a shift sheet reads. Codes open to every specialty that a dermatology physician also bills (general assessments, forms, special visit premiums) live in the Family Practice and Special visit premiums sets.
Each code links to its full Schedule entry: fee history, restrictions, required diagnoses and the codes it can or cannot be billed with. Fees shown are the current provider or specialist fee; percentage premiums show the percentage they add to the base service.
Common questions
Which consultation or assessment code does dermatology bill?
The consultations & assessments — office section of this set starts with A025 (Complex psoriasis or complex dermatitis). 7 codes are listed in that section.
What is in the Dermatology code set?
49 OHIP billing codes across 9 sections: Consultations & assessments — office; E-assessments; Hospital in-patient; Biopsy; Lesion treatment & excision; Intralesional, light & patch testing; Mohs & laser; Nails; Long-term care. Dermatology assessments including e-assessments, skin biopsy and lesion removal, intralesional and light therapy, Mohs surgery and nail procedures.
Are these the current OHIP fees?
Fees are read from the current Ontario Schedule of Benefits for Physician Services and refreshed hourly. Claims are paid at the fee in force on the service date, so always confirm the effective date on the code page.
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