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Billing code

R045A — Rotation, transposition or Z-plasty flap — defect under 2 cm — face, neck or scalp

Small rotation flap, face

Bill R045 for a rotation, transposition or Z-plasty flap closing a defect under 2 cm average diameter on the face, neck or scalp.

Watch for: When a lesion excision is closed with this flap, claim the flap code instead of the excision code.

Code

R045A

Description

Rotation, transposition or Z-plasty flap — defect under 2 cm — face, neck or scalp

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

Rotation, transposition or Z-plasty flap for a defect under 2 cm average diameter on the face, neck or scalp.

What it covers

Rotations, transpositions and Z-plasties include undermining, depending on site and size (M17).

Defect less than 2 cm average diameter: R045 face, neck or scalp; R072 other areas. Larger defects are R046/R075 (2.1–5 cm), R047/R073 (5.1–10 cm) and R076/R074 (over 10 cm) (M17, M18).

Billing rules

• When a benign, pre-malignant or malignant lesion excision is closed this way, claim this flap code instead of the excision code (M6, M17).
• Add E540 (+25%) once per lesion when the excision is done in hospital for tumour-free margins with frozen section, to the first flap or graft (M17).
• Procedures other than the skin flap, such as tendon grafts, are payable in addition (M17).
• The # prefix means the fee does not include premises, equipment, supplies and personnel at the place where the procedure itself is done (SP1).
• Assistant units are listed: a surgical assistant claims with suffix B (SP5 §21, GP85).
• Age premiums apply to surgical procedures for children: +30% under 30 days down to +10% for ages 5 to 15 (GP64).

Often billed with

• E540 frozen-section margin control in hospital (M17).
• R081 Mohs surgery when closure is more complex than an advancement flap (M8).

Related codes: R072, R046, R047, R011, R048, R081

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, page M17.

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