< Billing codes

Billing code

R522A — Muscle - Simple

Simple muscle excision

Bill R522 for a simple excision of muscle in the hand, shoulder, hip, thigh, leg or foot.

Watch for: Use R523 instead when the muscle excision is complex.

Code

R522A

Description

Muscle - Simple

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 muscle, listed in the hand, shoulder, hip, femur, leg and foot surgery sections. Complex muscle excision is R523.

What it covers

R522 is the simple muscle listing under Excision in the Musculoskeletal System Surgical Procedures section, first under Hand and Wrist (N12) and again for the shoulder, arm and chest (N24), pelvis and hip (N38), femur (N41), fibula and tibia (N50) and foot and ankle (N55). R523 is the complex version (N12), and excision for myositis ossificans is R524 (N18, N38).

As a surgical procedure without a Z prefix, the fee includes preparing the patient, the operation, recovery-room care, arranging follow-up and post-operative care until the first post-operative visit (SP1). It is marked #: the fee doesn't include the premises, equipment, supplies and staff for the procedure itself (SP1).

Billing rules

• Choose R522 for a simple excision and R523 for a complex one (N12).
• The major pre-operative visit (where the decision to operate is made) is billed separately (GP4, SP2).
• Surgical assistant: 6 basic units plus time units (R522B); anaesthetist: 6 basic units plus time units (R522C) (N12, GP85, SP5).
• With other procedures under the same anaesthetic, the major procedure is paid in full and the others at 85% (SP2).
• Listed fees are for unilateral procedures unless the Schedule says otherwise (SP4).
• Age premiums apply to patients under 16 (GP64).

Often billed with

• A034 partial assessment (General Surgery) when it is the major pre-operative visit (GP4, SP2).

Related codes: R523, R524, R592, Z228, Z219

Source: Schedule of Benefits (July 1, 2026), Musculoskeletal System Surgical Procedures, Hand and Wrist, Excision - Muscle, pages N11-N12 (also N24, N38, N41, N50, N55); Surgical Preamble SP1-SP5; General Preamble GP4, GP85

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing