What are the billing rules for R035A?

Use R054 instead when the patient's BMI is greater than 40 (M4). Use R036 when the excision includes a skin shift (M4). The major pre-operative visit is billed separately whenever it took place; the surgeon can't bill a hospital or day care admission assessment unless it is that visit (GP4, SP2).

What is R035A often billed with?

A034 General Surgery partial assessment, billable on the surgery day only if it is the major pre-operative visit (GP4, SP2). U990 or U991 hospital out-patient special visit premiums, for a non-elective procedure on a special visit that meets the Table II rules (SP2, GP65, GP71).

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Billing code

R035A — Group 4 - Other Lesions - Pilonidal Cyst - Simple Excision Or Marsupialization

Q: What is OHIP billing code R035A?

Simple excision or marsupialization of a pilonidal cyst. Use R054 when the patient's BMI is over 40, and R036 for excision with skin shift.

Pilonidal cyst excision

Bill R035 for simple excision or marsupialization of a pilonidal cyst.

Watch for: Use R054 instead when the patient's BMI is over 40, and R036 when the excision includes a skin shift.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$219.10	$0.00	$0.00	$95.76	$95.76

Code: R035A
Description: Group 4 - Other Lesions - Pilonidal Cyst - Simple Excision Or Marsupialization
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

Simple excision or marsupialization of a pilonidal cyst. Use R054 when the patient's BMI is over 40, and R036 for excision with skin shift.

What it covers

R035 is simple excision or marsupialization of a pilonidal cyst, listed under Group 4, other lesions, in the excision listings of Skin and Subcutaneous Tissue (M4).

The same procedure in a patient with a BMI greater than 40 is R054, and excision with skin shift is R036 (M4). Incision and drainage of a pilonidal abscess is a separate Z code: Z106 under local anaesthetic, Z107 under general anaesthetic (M1).

Billing rules

Use R054 instead when the patient's BMI is greater than 40 (M4).
Use R036 when the excision includes a skin shift (M4).
The major pre-operative visit is billed separately whenever it took place; the surgeon can't bill a hospital or day care admission assessment unless it is that visit (GP4, SP2).
For a non-elective procedure done on a special visit, bill the consultation or assessment, the special visit premium and R035; evenings, nights, weekends and holidays also take E409 or E410 (SP2).
Age premiums apply to surgical procedures for patients under 16 (GP64).
Marked #: premises, equipment, supplies and personnel are not included in the fee (SP1, GP13).

Often billed with

A034 General Surgery partial assessment, billable on the surgery day only if it is the major pre-operative visit (GP4, SP2).
U990 or U991 hospital out-patient special visit premiums, for a non-elective procedure on a special visit that meets the Table II rules (SP2, GP65, GP71).

Related codes: R054, R036, Z106, Z107, A034, U990

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, Excision Group 4 (other lesions), Pilonidal cyst, page M4; Surgical Preamble SP2

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