What are the billing rules for R081A?

Only for physicians with generally accepted specialized Mohs training, e.g. an American College of Mohs Surgery fellowship (M8). You must prepare or supervise slide preparation and personally review all sections. If a pathologist interprets or bills for the slides, R081 and E524 are not payable; claim the malignant excision code instead (M8). Once per lesion, including when the excision is completed over up to two weeks (M8).

What is R081A often billed with?

E524 for one or more additional cuts (M8). Rotation, transposition or Z-plasty flaps such as R045/R072 when complex closure is needed (M8, M17).

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Billing code

R081A — Mohs micrographic surgery — initial cut

Q: What is OHIP billing code R081A?

Mohs micrographic surgery for a qualifying, histologically confirmed skin cancer: the initial cut, including debulking.

Mohs surgery, initial cut

Bill R081 for the initial cut, including debulking, of Mohs surgery on a confirmed skin cancer that meets at least one qualifying condition.

Watch for: If a pathologist interprets or bills the slides, R081 isn't payable; claim the malignant excision code instead.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$315.45	$0.00	$77.46	$111.72	$111.72

Code: R081A
Description: Mohs micrographic surgery — initial cut
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

Mohs micrographic surgery for a qualifying, histologically confirmed skin cancer: the initial cut, including debulking.

What it covers

Mohs surgery is payable for a histologically confirmed cutaneous malignancy (e.g. basal cell or squamous cell carcinoma, melanoma, lentigo maligna, dermatofibrosarcoma protuberans, Merkel cell carcinoma) that meets at least one condition: clinical margins over 1.5 cm; an anatomically sensitive site (periocular, perinasal, perilabial, periauricular, nose); recurrence after prior therapy; immunodeficiency or a predisposing genodermatosis; or a histologically aggressive lesion (M8).

R081 is the initial cut, including debulking; each lesion's additional cuts are E524 (M8).

Billing rules

Only for physicians with generally accepted specialized Mohs training, e.g. an American College of Mohs Surgery fellowship (M8).
You must prepare or supervise slide preparation and personally review all sections. If a pathologist interprets or bills for the slides, R081 and E524 are not payable; claim the malignant excision code instead (M8).
Once per lesion, including when the excision is completed over up to two weeks (M8).
A second lesion the same day is paid at 85% (with or without E524); three or more lesions go to independent consideration with an operative report (M9).
Closure by undermining and advancement flaps is included; more complex closure may be billed with Skin Flaps and Grafts codes (M8).
An aggressive histology not listed in the definition may be considered by independent consideration (M9).
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

E524 for one or more additional cuts (M8).
Rotation, transposition or Z-plasty flaps such as R045/R072 when complex closure is needed (M8, M17).

Related codes: E524, R048, R094, R010, R045, R072, R046, R075

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, page M8–M9.

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