What are the billing rules for Z116A?

Z116 may be allowed more than once only on an IC basis, when medically necessary to make a diagnosis or plan treatment: to biopsy more than one lesion, or to take a second biopsy from an extensive lesion (M1). E542 is added when the biopsy is done outside hospital (M1). If you did the major pre-operative visit in the previous 12 months, only a minor assessment (GP/FP) or a partial assessment (specialist) is payable before the biopsy that day; if the decision is made at that day's visit, that visit is the major pre-operative visit and no other assessment before the biopsy is payable (GP4, SP4).

What is Z116A often billed with?

A007 intermediate assessment at the visit where the decision to biopsy is made (GP4, SP4). E542 when the biopsy is done in the office or elsewhere outside hospital (M1). Z117 chemical treatment of a lesion, which the M1 note says may be allowed with Z116 (M1).

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Billing code

Z116A — Biopsy(ies) - any method, when sutures are used

Q: What is OHIP billing code Z116A?

Biopsy of one or more skin or subcutaneous lesions, by any method, when the site is closed with sutures. A second Z116 is paid only on an IC basis.

Skin biopsy with sutures

Bill for a biopsy of one or more skin or subcutaneous lesions, by any method, when the site is closed with sutures.

Watch for: Without sutures bill Z113; a second Z116 is paid only by independent consideration.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$32.45	$0.00	$0.00	$0.00	$0.00

Code: Z116A
Description: Biopsy(ies) - any method, when sutures are used
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

Biopsy of one or more skin or subcutaneous lesions, by any method, when the site is closed with sutures. A second Z116 is paid only on an IC basis.

What it covers

Z116 is a biopsy, by any method, when sutures are used to close the site (M1). When sutures are not used the code is Z113, and an extensive or complicated biopsy, or one needing a general anaesthetic as the sole procedure, is Z155, an IC code (M1, M2).

As a Z code it is an independent operative procedure (IOP), payable in addition to an assessment (GP4).

Billing rules

Z116 may be allowed more than once only on an IC basis, when medically necessary to make a diagnosis or plan treatment: to biopsy more than one lesion, or to take a second biopsy from an extensive lesion (M1).
E542 is added when the biopsy is done outside hospital (M1).
If you did the major pre-operative visit in the previous 12 months, only a minor assessment (GP/FP) or a partial assessment (specialist) is payable before the biopsy that day; if the decision is made at that day's visit, that visit is the major pre-operative visit and no other assessment before the biopsy is payable (GP4, SP4).
An unrelated, significant problem in another body system assessed and treated at the same visit can be billed as well (SP4).
FHO: a Schedule 2 core service and one of the Schedule 2B codes with 50% total shadow billing for enrolled patients; it also counts toward the Schedule 4 office procedures payment when done in the office (Agreement p.59 §4.4, p.80, p.87, p.67 §8.7, p.94).

Often billed with

A007 intermediate assessment at the visit where the decision to biopsy is made (GP4, SP4).
E542 when the biopsy is done in the office or elsewhere outside hospital (M1).
Z117 chemical treatment of a lesion, which the M1 note says may be allowed with Z116 (M1).

Related codes: Z113, Z117, E542, Z156, R094, A007

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, Biopsy(ies), page M1 (Z155 on M2); General Preamble GP4; Surgical Preamble SP4

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