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Billing code

Z162A — Group 2 - Nevus - Removal By Excision And Suture - Single Lesion

Mole excision

Bill for excising and suturing one benign nevus (mole); two are Z163 and three or more Z164.

Watch for: Use a valid diagnostic code for the lesion removed; cosmetic removal without suspicion of disease isn't insured.

Code

Z162A

Description

Group 2 - Nevus - Removal By Excision And Suture - Single Lesion

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

Excision and suture of one benign nevus (mole). Two are Z163, three or more Z164; removal for cosmetic reasons isn't insured.

What it covers

Z162 is removal of a single Group 2 lesion, a nevus, by excision and suture, with or without biopsy (M3). Appendix D Surface Pathology, Section 4, sets when benign lesions such as nevi are insured (M3, AD3).

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

Billing rules

• One lesion only: two nevi are Z163, three or more Z164, and an extensive congenital nevus is Z165 (IC) (M3).
• E542 is added when the excision is done outside hospital (M3).
• Removal of lesions for cosmetic purposes, without clinical suspicion of disease or malignancy, is not an insured service (M3); such removals are billed to the patient (AD3).
• On the face or neck, excision of a nevus is insured where there is any suspicion of disease or malignancy; in other areas it is normally not insured when it is only to alter appearance (AD3).
• A dysplastic nevus counts as a pre-malignant lesion, with its own excision codes, R160 to R165, paid at a lesser fee if the pathologist's report isn't kept in the record (M5).
• 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 excision 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 excision is payable (GP4, 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.82, p.88, p.67 §8.7, p.95).

Often billed with

• A007 intermediate assessment at the visit where the decision to excise is made (GP4, SP4).
• E542 when the excision is done in the office or elsewhere outside hospital (M3).

Common rejections

• V22: The diagnostic code isn't a valid OHIP code. Replace it with the three-digit code for the lesion removed and resubmit.

Related codes: Z163, Z164, Z156, R160, R163, E542

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, Excision (with or without biopsy), Group 2, page M3; pre-malignant lesions M5; Appendix D AD3; Surgical Preamble SP4

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