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Billing code

E676A — Morbidly obese patient premium, surgeon or assistant

Morbid obesity surgery premium

Surgeon adds 25% (E676A) or assistant adds 6 units (E676B) for listed major surgery under general anaesthesia when BMI is over 40.

Watch for: The BMI must be recorded in the chart; once per patient per physician, and only with the listed procedure codes.

Code

E676A

Description

Morbidly obese patient premium, surgeon or assistant

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Morbid obesity premium: surgeon +25% (E676A) or assistant +6 units (E676B) for major surgery under general anaesthesia when BMI is over 40.

What it covers

E676 is a Surgical Preamble premium for a morbidly obese patient having major surgery to the neck, thorax, peritoneal cavity, retroperitoneum, pelvis or hip (SP6). E676A adds 25% to the surgeon's procedural fee(s); E676B adds 6 units to the surgical assistant's fee for the major procedure (SP6).

All three conditions must be met: BMI over 40; general anaesthesia (any anaesthesia other than topical or local infiltration, GP3), with an open technique for the neck, thorax or hip, or an open or laparoscopic technique for the peritoneal cavity, pelvis or retroperitoneum; and a principal technique that is not aspiration, core or fine needle biopsy, dilation, endoscopy, mediastinoscopy, thoracoscopy, cautery, ablation or catheterization (SP6).

Billing rules

• Payable once per patient per physician, in addition to the major surgical procedure(s) (SP6).
• Only payable with the procedure codes listed on SP6, for example P018, P041, P042, S460 and E499 (SP6).
• The BMI must be recorded in the patient's permanent medical record (SP7).
• Not payable when the surgery is done under local anaesthesia; spinal or epidural anaesthesia counts as general anaesthesia for this rule (SP7, GP3).

Often billed with

• P018 caesarean section, which is on the SP6 eligible list (SP6, K6).
• E400B or E401B, the assistant's after-hours premiums, when the assistant's case starts after hours (GP87).
• S460 and other listed major open or laparoscopic procedures (SP6).

Related codes: P018, P041, P042, S460, E673, E499

Source: Schedule of Benefits (July 1, 2026), Surgical Preamble, paragraph 24 (Morbidly obese patients), pages SP6-SP7; General Preamble definitions GP3

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