What are the billing rules for R094A?

The amount payable is adjusted to a lesser fee if the pathologist's report isn't retained in the patient's record (M6). For two lesions bill R040, and for three or more R041, rather than repeating R094 (M6). If the defect is closed by an advancement flap with more than 2.5 cm of undermining per side, a rotation, transposition or Z-plasty, or another flap or graft, claim the Skin Flaps and Grafts benefit instead of the excision fee. S-plasty is simple excision (M6).

What is R094A often billed with?

E542 when the excision is done in the office (M6). A007 intermediate assessment at the visit where the decision to excise is made; that is the major pre-operative visit and is billed separately (GP4, SP2).

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Billing code

R094A — Malignant lesion Other - single, simple excision

Q: What is OHIP billing code R094A?

Simple excision of one malignant skin lesion outside the face and neck, biopsy included. Paid at a lesser fee if the pathology report isn't kept.

Skin cancer excision, body, one

Bill R094 for simple excision of one malignant skin lesion outside the face and neck, including biopsy of the lesion.

Watch for: Keep the pathologist's report in the record, or OHIP pays a lesser fee; bill R040 or R041 for more lesions.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$63.70	$0.00	$77.46	$111.72	$111.72

Code: R094A
Description: Malignant lesion Other - single, simple excision
FHO+ basket: Covered by the FHO+ base rate payment for enrolled patients, and shadow billed at 30% (50% for Schedule 2B procedures).
Effective date: Apr 1, 2026
Termination date: No end date

Explanation

Updated October 26, 2026

Simple excision of one malignant skin lesion outside the face and neck, biopsy included. Paid at a lesser fee if the pathology report isn't kept.

What it covers

R094 is simple excision of a single malignant skin lesion in areas other than the face or neck, including biopsy of the lesion (M6). Two lesions are R040 and three or more R041; face or neck lesions are R048 to R050 (M6).

A pre-malignant lesion is not a malignant lesion for payment; in other areas those are R163 to R165 (M5, M6). In-situ lesions such as lentigo maligna and Bowen's disease count as malignant (M5).

Billing rules

The amount payable is adjusted to a lesser fee if the pathologist's report isn't retained in the patient's record (M6).
For two lesions bill R040, and for three or more R041, rather than repeating R094 (M6).
If the defect is closed by an advancement flap with more than 2.5 cm of undermining per side, a rotation, transposition or Z-plasty, or another flap or graft, claim the Skin Flaps and Grafts benefit instead of the excision fee. S-plasty is simple excision (M6).
Wide excision of malignant melanoma with margins over 1 cm and layered closure is R010 (M6).
Add E542 when performed outside hospital (M6).
FHO: in basket (Schedule 2), and a Schedule 2B code, so shadow billing for enrolled patients is 50% of the fee; it also counts toward the Schedule 4 office procedures payment (Agreement p.59 §4.4, p.80, p.87, p.67 §8.7, p.93).

Often billed with

E542 when the excision is done in the office (M6).
A007 intermediate assessment at the visit where the decision to excise is made; that is the major pre-operative visit and is billed separately (GP4, SP2).

Related codes: R040, R041, R048, R031, R163, R010, E542

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, Malignant lesions including biopsy, Other areas, page M6 (with M5); FHO Agreement 2026-04 pp.59, 80, 87, 93

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