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Billing code

R164A — Pre-malignant skin lesion — simple excision, other areas — two lesions

Pre-cancerous lesion excision, body, two

Bill R164 for simple excision of two pre-malignant skin lesions, such as dysplastic nevi or actinic keratoses, outside the face or neck.

Watch for: Only for the listed pre-malignant lesions; keep the pathologist's report in the record, or OHIP pays a lesser fee.

Code

R164A

Description

Pre-malignant skin lesion — simple excision, other areas — 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 pre-malignant skin lesions (e.g. dysplastic nevus, actinic keratosis) outside the face or neck, with biopsy.

What it covers

Excision of pre-malignant lesions, including biopsy of each lesion, single or multiple sites. The series for other areas is R163–R165; R160–R162 for the face or neck (M5).

Payable only for: dysplastic nevus (incl. atypical melanocytic hyperplasia or proliferation), actinic/solar keratosis, chemical and other pre-malignant keratoses, large cell acanthoma, erythroplasia of Queyrat, and leukoplakia (M5).

Billing rules

• Only for the lesions listed on M5; in-situ lesions such as lentigo maligna and Bowen's disease are malignant, so use the malignant excision codes (M5).
• Keep the pathologist's report in the patient's record, or OHIP pays a lesser fee (M5).
• Add E542 when performed outside hospital (listed under this group; M5).
• 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).
• Cryotherapy of 5 or more actinic keratoses with liquid nitrogen is Z119 (diagnostic code 232); fewer lesions are Z117 (M5).
• Multiple procedures under the same anaesthetic: full fee for the major procedure, 85% for the others (SP2 §3).
• Age premiums apply to surgical procedures for children: +30% under 30 days down to +10% for ages 5 to 15 (GP64).

Often billed with

• E542 outside hospital (M5).

Related codes: R163, R165, R160, R161, R162, R040, Z119, Z117

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, page M5.

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