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Surgical specialties & anaesthesia
Plastic Surgery OHIP billing codes
Plastic surgery consultations, skin lesions and biopsy, lacerations and scars, grafts and flaps, hand surgery, breast, face and burns.
106 codes in 11 sections, fees from the current Schedule of Benefits. Every code the Schedule lists for specialty 08 is in the full Plastic Surgery listing.
Consultations & assessments — office
- A085ConsultationConsultation - Plastic Surgery—
- A086Repeat consultation—
- A083Specific assessmentA specific assessment rendered by a Plastic Surgery specialist, requiring a detailed history and examination of the affected part, region, or system to make a diagnosis or assess function. This service is performed in a location other than the patient's home.—
- A084Partial assessment—
Hospital in-patient
- C085ConsultationConsultation - Plastic Surgery—
- C089Plastic Surgery - ConsultationSubsequent visit - after 13th week—
- C086Repeat consultationRepeat consultation - Plastic Surgery, Hospital In-patient—
- C083Specific assessmentSpecific assessment - Plastic Surgery, Hospital In-Patient—
- C084Specific re-assessmentSpecific re-assessment (Plastic Surgery)—
- C082Subsequent visit - first five weeksSubsequent visit - first five weeks (per visit)—
- C087Subsequent visitSubsequent visit, 6th to 13th week inclusive (maximum 3 per patient per week)—
- C088Concurrent careConcurrent care (per visit)—
Skin lesions & biopsy
- Z113Biopsy - any method, when sutures are not used$32.45
- Z116Biopsy - any method, when sutures are usedBiopsy - any method, when sutures are used.$32.45
- 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
- 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
- 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
- R050Malignant lesions - three or more lesions (face or neck)Simple excision of three or more malignant lesions from the face or neck. A pathologist's report must be retained in the patient's record for full payment. If repair requires a flap or graft, the appropriate repair code should be billed instead.$255.25
- 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
- R160Simple excision of pre-malignant lesion - Face or NeckSimple excision of a single pre-malignant lesion on the face or neck.$58.30
- R163Simple excision of pre-malignant lesion - Other AreasSimple excision of pre-malignant lesion - Other Areas - single lesion$47.75
- 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
Lacerations, wounds & scars
- Z154Repair of laceration - up to 5 cm if on face and/or requires tying of bleeders and/or closure in layersSurgical repair of a laceration up to 5 cm in length, located on the face, and/or requiring the tying of bleeders or closure in layers.$39.35
- Z177Repair of laceration, 5.1 to 10 cm, complexRepair of a laceration 5.1 to 10 cm in length. This service applies if the laceration is on the face or requires complex closure, such as tying bleeders or layered suturing.$78.15
- Z190Laceration repair, 10.1 to 15 cm, complexSurgical repair of a laceration between 10.1 cm and 15 cm in length, which is either located on the face, requires the tying of bleeders, or requires closure in layers.$111.20
- Z192Repair of laceration - more than 15.1 cm - on faceSurgical repair for a facial laceration greater than 15.1 cm in length. This is a surgical procedure allowing for surgeon, assistant, and anaesthetist fees, with specific add-ons and payment rules.$169.75
- Z187Complex laceration repair, faceA complex repair of a facial laceration requiring a minimum of 20 minutes of surgical time and involving either anatomical alignment of key facial features, closure of three or more layers, or ligation of multiple bleeding vessels.$101.15
- Z188Complex laceration repair, anatomical area other than faceRepair of a complex laceration on the body, excluding the face and zone 1 of digits, that requires a minimum of 20 minutes to perform and involves either multi-layer closure or ligation of multiple bleeding vessels.$101.15
- Z189Complex repair, digit, zone 1 repair, without soft tissue lossComplex repair of a zone 1 digit injury without soft tissue loss, requiring a minimum of 20 minutes of repair time. Paid per digit.$101.15
- R021Scar revision - face or neck - up to 2.5 cmSurgical revision of a scar up to 2.5 cm in length on the face or neck. This surgical procedure fee is for the surgeon and includes any method of closure. Assistant and anaesthesia services are eligible for separate billing.$115.60
- Z080Debridement of wound(s) and/or ulcer(s) extending into subcutaneous tissue - oneDebridement of one wound or ulcer extending into subcutaneous tissue. The service must be rendered personally by the physician, involve a minimum of 10 minutes of debridement time, and includes any necessary dressing.$21.90
- Z081Debridement of two wounds or ulcers extending into subcutaneous tissueDebridement of two wounds or ulcers extending into subcutaneous tissue. This service must be rendered personally by the physician for a minimum of 10 minutes.$32.90
- Z082Debridement of wound(s) and/or ulcer(s) extending into subcutaneous tissue - threeDebridement of three wounds or ulcers that extend into subcutaneous tissue. This service requires a minimum of 10 minutes of debridement time and must be rendered personally by the physician. Refer to <SectionPages>M10</SectionPages>.$49.30
Skin grafts
- R084Split thickness skin graft - very minorSurgical procedure from the Musculoskeletal System section of the OHIP Schedule of Benefits. Assistant services are not eligible for payment.$92.30
- R085Split thickness skin graft - minor, medium sized areasR085 is a surgical procedure for the Integumentary System. The description is 'Minor, medium sized areas, e.g. small or skin ulcer, breast, etc'. This code is billable by the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C).$140.25
- R086Intermediate, large areas skin graftSurgical procedure for the excision of the submandibular gland. This fee is for the surgeon's professional service (A), surgical assistant (B), and anaesthetist (C).$259.10
- R083Full thickness graft - major, over 5 cmUnspecified surgical procedure. The assistant fee is calculated from 6 basic units and the anaesthetist fee from 7 basic units. Payment for a second assistant requires prior authorization.$280.15
- R093Full thickness skin graft - intermediate (1 cm to 5 cm)Surgical procedure from the Integumentary System section. As the specific content for this code was not provided, a detailed description is unavailable. General surgical rules apply.$178.90
- R092Minor full thickness graft - less than 1 cm average diameterMinor - less than 1 cm average diameter$116.65
- R091Complex full thickness graft - eyelid, nose, lip, faceComplex full thickness graft - eyelid, nose, lip, face. This is a surgical procedure within the Integumentary System.$263.95
- R087Major, complex areas skin graftMajor, complex areas, e.g. face, neck, hands$388.00
Flaps
- R002Advancement flap - other areas (Defect 2.1 to 5 cm)Surgical procedure involving an advancement flap to repair a skin defect measuring 2.1 to 5 cm on areas of the body other than the face, neck, or scalp.$67.40
- R003Advancement flap - other areas - defect 5.1 to 10 cmSurgical creation of an advancement flap to repair a skin defect measuring 5.1 to 10 cm in size on areas other than the face, neck, or scalp. Includes undermining and may include lesion excision.$161.75
- R004Advancement flap - defect more than 10 cmSurgical repair of a large skin defect (>10 cm) using an advancement flap, such as a thoracic abdominal flap. This procedure includes the excision of a lesion if it is the technique of closure.$242.70
- R011Advancement flap - face, neck or scalp - defect 2.1 to 5 cmSurgical procedure for an advancement flap on the face, neck, or scalp to repair a defect between 2.1 and 5 cm. This includes undermining of more than 2.5 cm per side and the excision of a lesion if used for closure.$89.85
- R012Advancement flap - face, neck or scalp - defect 5.1 to 10 cmSurgical procedure for an advancement flap to repair a defect between 5.1 and 10 cm on the face, neck, or scalp. This includes undermining and may include the excision of a lesion.$247.15
- R072Rotations, transpositions, Z-plasties - other areas - Defect less than 2 cm average diameterA surgical procedure for the repair of a skin defect less than 2 cm in average diameter using a rotation, transposition, or Z-plasty flap. This code applies to areas *other than* the face, neck, or scalp and includes undermining.$133.40
- R070Pedicle flaps - Small/IntermediateSurgical creation of a small or intermediate pedicle flap, such as a cross finger or cervical finger flap, representing the initial stage of a reconstructive procedure.$293.75
- R071Pedicle flap - each subsequent stageA surgical procedure for each subsequent stage of creating a small or intermediate pedicle flap, typically following an initial procedure like `<billingCode>R070</billingCode>`.$223.35
- R080Large pedicle flapSurgical procedure for the creation of a large pedicle flap, such as a cross leg, deltopectoral, or forehead flap. This code is for the initial stage of the procedure.$416.30
- R078Pedicle flap - each subsequent stageThis surgical procedure is for each subsequent stage of a large pedicle flap, which follows an initial flap creation like a cross leg, deltopectoral, or forehead flap.$311.45
- R005Myocutaneous, myogenous or fascia-cutaneous flaps - specific muscle flapsA surgical procedure on the integumentary system. As per <SectionPages>GP90</SectionPages>, the service of a second assistant for R005 is only eligible for payment following authorization by a medical consultant.$545.00
- R006Pectoralis major flapSurgical procedure for posterior spinal instrumentation. This code is for the surgeon's fee and can be billed with premiums for age, after-hours, and trauma. Assistant (B suffix) and anaesthetist (C suffix) services are billed separately.$734.95
- R008Lower transverse rectus abdominus flap$984.55
Hand
- N290Decompression median nerve at wrist (carpal tunnel syndrome)A surgical procedure for the decompression and release of the carpal tunnel, which involves relieving pressure on the median nerve.$197.15
- R551Excision of fascia for Dupuytrens (palmar fibromatosis), single raySurgical excision of the fascia for a single ray in the hand to treat Dupuytren's contracture, also known as palmar fibromatosis. This procedure may or may not involve skin flaps and includes the palmar and digital components.$322.15
- R536Tendon release (open) - finger/palmA surgical procedure involving the open release of one tendon in the finger or palm. For additional tendon releases during the same operation, see add-on code `<billingCode>E592</billingCode>`.$186.35
- R541Flexor tenolysis with pulley preservationA surgical procedure for the release of a flexor tendon in the hand or wrist, which includes the preservation of the tendon pulley system.$309.00
- R549Ganglion - simple or complexA surgical procedure on the hemic or lymphatic system, eligible for surgeon (`<suffix>A</suffix>`), assistant (`<suffix>B</suffix>`), and anaesthetist (`<suffix>C</suffix>`) fees. Subject to various premiums based on patient age and time of service.$221.80
- R585Suture flexor tendon - singleSurgical procedure for suture of a single flexor tendon. Assistant and anaesthesia services are eligible.$433.10
- R578Suture extensor tendon and/or open repair acute or chronic boutonniere deformityRepresents a cardiovascular surgical procedure. Payment for the surgeon (suffix A) includes pre-operative assessment and normal post-operative care. Fees for assistant (suffix B) and anaesthesia (suffix C) are calculated based on time and basic units.$276.10
- R580LeFort I cleft palate - in one segmentA LeFort I osteotomy in one segment for a patient with a cleft palate. This surgical procedure includes the harvesting and grafting of any necessary bone or cartilage.$1525.30
- R581Tenotomy - more than one toeSurgical procedure for the open tenotomy (cutting of a tendon) of more than one toe.$226.05
- R601Metacarpal phalangeal repairSurgical repair of a ligament of a metacarpal phalangeal joint.$371.05
- R608Phalanx, metacarpal or metacarpophalangeal joint amputationA surgical procedure for the amputation of a metacarpal or at the metaphalangeal joint.$269.30
- D006Open reduction - Metacarpal/phalangeal dislocationSurgical procedure for the open reduction of a metacarpal/phalangeal dislocation.$282.70
- D007Closed reduction of carpal dislocationSurgical procedure for the closed reduction of a dislocation of one or more carpal bones. This is a non-operative manipulation to realign the bone(s).$128.05
- F019Open reduction of scaphoidSurgical open reduction of a scaphoid (carpal navicular) bone fracture.$637.30
- F010Open reduction - intra-articularSurgical procedure for the open reduction of an intra-articular fracture of the hand or wrist.$419.00
- F011Open reduction of metacarpal fractureSurgical procedure for the open reduction of a metacarpal fracture. Use add-on code <billingCode>E559</billingCode> for each additional metacarpal open reduction.$320.80
- F007Open reduction of phalanx fractureSurgical procedure for the open reduction of a single phalanx fracture (a bone in the finger or toe).$346.50
- R629Revision of amputated finger tipA surgical procedure to revise an amputated fingertip. This procedure includes fees for the surgeon, assistant, and anaesthetist.$241.55
- R517Foreign body removalSurgical procedure performed on the musculoskeletal system. This service is eligible for anaesthesia but not for a surgical assistant.$107.70
Breast
- R107Tumour or tissue for diagnostic biopsy and/or treatmentSurgical excision of a breast tumour or tissue for diagnostic biopsy and/or treatment. This applies to single or multiple lesions in the same breast for conditions such as carcinoma, fibroadenoma, or fibrocystic disease.$169.95
- R102Level 1 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancyA surgical procedure for a Level 1 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy. Payment is contingent on the resected breast volume being 15% or less and specific surgical techniques being documented.$350.00
- R110Reduction mammoplasty (female, to include nipple transplantation or grafting, if rendered) - unilateralA unilateral reduction mammoplasty on a female patient, which includes nipple transplantation or grafting if performed. This procedure is for reasons other than post-mastectomy breast reconstruction balancing and requires prior authorization from the Ministry of Health.$472.15
- R114Revision of breast moundA surgical procedure for the revision of a previously reconstructed breast mound, typically as part of a multi-stage post-mastectomy breast reconstruction process.$230.30
- R118Breast skin reconstruction by local flaps or graftsA surgical procedure for post-mastectomy breast reconstruction using local skin flaps or grafts. This may include Wise pattern skin flaps and de-epithelialized skin flaps. It can be performed with add-on codes for prosthesis insertion (<billingCode>E529</billingCode>), soft tissue mound creation (<billingCode>E513</billingCode>), or as an immediate reconstruction after mastectomy (<billingCode>E514</billingCode>).$405.60
- R120Nipple-areola reconstruction by grafts and/or flapsA surgical procedure for post-mastectomy repair that reconstructs the nipple-areola complex using the patient's own tissue from grafts or flaps.$300.00
- R142Nipple-areola tattooing - unilateralA procedure for unilateral nipple-areola tattooing, performed as part of post-mastectomy breast reconstruction. See <SectionPages>M27</SectionPages>.$175.00
- R143Contralateral balancing mastopexy or reductionPerforms a contralateral balancing mastopexy or reduction, including nipple transplantation or grafting if necessary, as a balancing procedure following a mastectomy. This surgical service does not require prior authorization.$472.15
- R156Breast mound creation by insertion of tissue expanderBreast mound creation by insertion of tissue expander, includes creation of submuscular pocket$425.00
- Z132Insertion of tissue expanderSurgical insertion of a tissue expander. This procedure is not payable for post-mastectomy breast reconstruction and may require prior authorization. Add-on codes <billingCode>E527</billingCode> and <billingCode>E528</billingCode> apply for additional expanders.$304.10
- Z138Replacement of tissue expander by permanent prosthesisSurgical replacement of a tissue expander with a permanent prosthesis. This is typically a plastic surgery procedure.$195.85
- E514Immediate breast reconstruction following mastectomyProvides an additional fee for an immediate breast reconstruction procedure performed at the same surgical session as a mastectomy. This code must be billed in addition to a primary reconstruction code such as `R118` or `R125`.$200.00
- Z182Breast capsulectomySurgical procedure eligible for surgeon (A), assistant (B), and anaesthetist (C) fees. The fee for assistant and anaesthetist is calculated using base and time units. This code is eligible for various add-on premiums, including for age, after-hours services, and trauma.$255.05
Face & eyelids
- E192PtosisSurgical repair of ptosis, a condition characterized by the drooping of the upper eyelid. This is a hospital-based procedure.$578.30
- E198Laceration, full thickness - including lid marginSurgical repair of a full-thickness laceration of the eyelid that includes the lid margin. This service is typically performed under general anaesthetic in a hospital setting and is eligible for anaesthesia fees.$573.15
- E199Laceration, full thicknessSurgical repair of a full thickness laceration of the eyelid, not including the lid margin.$452.65
- E301Resection of pinna - with local flapA surgical procedure involving the excision of the external ear (pinna) and reconstruction using a local tissue flap.$355.35
- R387Genioplasty - two segments, or for laterognathiaA surgical procedure for genioplasty involving two segments or performed for laterognathia.$575.45
- F136Nasal bones - closed reduction$102.35
- F137Nasal bones - open reductionAn open reduction of a nasal bone fracture, which includes the manipulation of the nasal septum. This procedure can be augmented with miniplates.$316.35
Burns
- R637Debridement and excision, per % of total body treated other than hand, head or neckSurgical debridement and excision of burned tissue performed outside of an operating room. This service is paid per percentage of total body surface area treated, excluding the hand, head, or neck.$32.50
- R660Burn debridement and excision - hand - each digitPerforms debridement and excision for burns on a single digit of the hand, in a setting outside of the operating room.$31.65
- R661Burn debridement and excision - dorsum, palmSurgical debridement and excision of a burn on the dorsum or palm of the hand, performed outside of an operating room. This service is billable for each site (dorsum or palm) treated.$52.55
- R662Burn debridement and excision - nose, cheek, lip, ear, forehead, scalp, neck, eyelidSurgical debridement and excision of a burn on a specified head or neck area, such as the nose, cheek, lip, ear, forehead, scalp, or neck. This service is performed outside of an operating room and is billable for each distinct site treated.$31.65
Add-ons
- E556Extensive debridement of compound fractures or dislocationsAdds a 50% premium to the fee for a reduction of a compound fracture or dislocation to account for extensive debridement.+50%
- E977Excision for tumour free margin with frozen sectionA 25% premium added to the fee for eligible excision or repair codes (E222, E223, E225, E226, E227, E228, E229, E300) when the procedure is performed in a hospital to achieve tumour-free margins, confirmed by frozen section analysis.+25%
- E527Additional tissue expander, same incisionAn add-on fee for placing an additional tissue expander through the same surgical incision as the primary expander insertion.$58.95
How to use this plastics code set
This is a working list, not the whole Schedule. It carries the codes the Ontario Schedule of Benefits ties to plastic surgery (specialty 08) — 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 plastics 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 plastic surgery bill?
The consultations & assessments — office section of this set starts with A085 (Consultation). 4 codes are listed in that section.
What is in the Plastic Surgery code set?
106 OHIP billing codes across 11 sections: Consultations & assessments — office; Hospital in-patient; Skin lesions & biopsy; Lacerations, wounds & scars; Skin grafts; Flaps; Hand; Breast; Face & eyelids; Burns; Add-ons. Plastic surgery consultations, skin lesions and biopsy, lacerations and scars, grafts and flaps, hand surgery, breast, face and burns.
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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