< Billing codes

Billing code

S207A — Appendectomy With Or Without Perforation

Appendix removal

Bill S207 for an appendectomy, whether the appendix is intact or perforated.

Watch for: S204, S313, S314, Z594 and E686 aren't payable with it, and an incidental normal appendix removal isn't claimed.

Code

S207A

Description

Appendectomy With Or Without Perforation

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

Appendectomy, with or without perforation. Use it whether the appendix is intact or ruptured.

What it covers

S207 is appendectomy with or without perforation (S23). Claim S207 whether the appendix is intact or ruptured (S23).

The surgical fee includes pre-operative preparation, the operation, recovery-room care and monitoring until the first post-operative visit; the major pre-operative visit is billed separately (SP1, SP2).

Billing rules

• S204, S313, S314, Z594 and E686 are not payable with S207 (S23).
• Removing a normal appendix incidentally during another operation is not claimed (SP2).
• With other procedures under the same anaesthetic, the major procedure is paid in full and the others at 85% (SP2).
• The surgeon cannot bill the hospital admission assessment unless it is the major pre-operative visit (SP2).
• Non-elective surgery on a special visit: bill the consultation or assessment, special visit premium and procedure; evenings, nights, weekends and holidays also take E409 or E410 (SP2, GP104).
• If a laparoscopic approach is converted to a laparotomy, E860 is payable in addition (SP5). Laparoscopy used only as the entry for the operation is not paid separately (S33).
• E676 morbid obesity premium may apply when BMI is over 40 and recorded in the chart (SP6, SP7).
• Age premium applies for patients under 16 (GP64).

Often billed with

• E409/E410 after-hours premium for non-elective surgery (GP104).
• E860 when a laparoscopic approach converts to laparotomy (SP5).
• E676 morbidly obese patient premium (SP6).

Related codes: S204, S313, S314, Z594, E686, E860, S312

Source: Schedule of Benefits (July 1, 2026), Digestive System Surgical Procedures, Miscellaneous, page S23.

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