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Billing code

R049A — Malignant skin lesion — simple excision, face or neck — two lesions

Skin cancer excision, face, two

Bill R049 for simple excision of two malignant skin lesions on the face or neck, including biopsy of each lesion.

Watch for: Keep the pathologist's report in the record, or OHIP pays a lesser fee; add E542 when done outside hospital.

Code

R049A

Description

Malignant skin lesion — simple excision, face or neck — two lesions

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 of two malignant skin lesions on the face or neck, including biopsy of each lesion.

What it covers

Simple excision of malignant skin lesions, including biopsy of each lesion, single or multiple sites. The face or neck series is R048–R050 (M6).

In-situ lesions such as lentigo maligna (melanoma in situ) and Bowen's disease count as malignant; pre-malignant lesions use R160–R165 (M5, M6).

Billing rules

• Use for two malignant lesions on the face or neck; R094/R040/R041 for other areas (M6).
• Keep the pathologist's report in the patient's record, or OHIP pays a lesser fee (M6).
• A pre-malignant lesion is not a malignant lesion for payment; in-situ lesions such as lentigo maligna and Bowen's disease count as malignant (M5, M6).
• If the excision defect is closed by an advancement flap with more than 2.5 cm undermining per side, a rotation, transposition or Z-plasty, or another flap or graft, claim the Skin Flaps and Grafts code instead of the excision code; S-plasty counts as simple excision (M6, M17).
• Add E542 when performed outside hospital (listed under this group; M6).
• Add E540 (+25%) when the excision is done in hospital for tumour-free margins with frozen section (M6).
• Age premiums apply to surgical procedures for children: +30% under 30 days down to +10% for ages 5 to 15 (GP64).
• FHO: a Schedule 4 office procedure for the office procedures special payment (Agreement p.67 §8.7, p.93).

Often billed with

• E542 outside hospital (M6).
• E540 for frozen-section margin control in hospital (M6).

Related codes: R048, R050, R094, R040, R041, R018, R019, E540

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, page M6.

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