What are the billing rules for Z164A?

Removal for cosmetic purposes, without clinical suspicion of disease or malignancy, is not insured and is billed to the patient (M3, AD3). Appendix D: on the face or neck, excision or destruction is insured when there is any suspicion of disease or malignancy; in other areas it is normally not insured if done only to alter appearance (AD3). A dysplastic nevus (nevus with dysplastic features or atypical melanocytic proliferation) is a pre-malignant lesion; use R160–R165 with the pathology report kept (M5).

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Billing code

Z164A — Nevus (Group 2) — excision and suture — three or more lesions

Q: What is OHIP billing code Z164A?

Removal of three or more nevi (Group 2 benign lesions) by excision and suture.

Three+ moles excised

Bill for excising and suturing three or more nevi (moles).

Watch for: A dysplastic nevus uses R160 to R165 instead; cosmetic removal isn't insured.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$48.50	$0.00	$0.00	$95.76	$95.76

Code: Z164A
Description: Nevus (Group 2) — excision and suture — three or more 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

Removal of three or more nevi (Group 2 benign lesions) by excision and suture.

What it covers

Group 2 is nevus; Z162 is a single lesion, Z163 two lesions and Z164 three or more, removed by excision and suture (M3).

Extensive congenital nevus is Z165, by independent consideration (M3).

Billing rules

Removal for cosmetic purposes, without clinical suspicion of disease or malignancy, is not insured and is billed to the patient (M3, AD3).
Appendix D: on the face or neck, excision or destruction is insured when there is any suspicion of disease or malignancy; in other areas it is normally not insured if done only to alter appearance (AD3).
A dysplastic nevus (nevus with dysplastic features or atypical melanocytic proliferation) is a pre-malignant lesion; use R160–R165 with the pathology report kept (M5).
Add E542 when performed outside hospital (listed under this group; M3).
A Z code is an independent operative procedure: if your decision-to-operate visit was in the prior 12 months, only a minor (GP) or partial (specialist) assessment is payable before it the same day (SP4 §13).
FHO: a Schedule 4 office procedure for the office procedures special payment (Agreement p.67 §8.7, p.95).

Often billed with

E542 outside hospital (M3).

Related codes: Z162, Z163, Z158, R162, R165

Source: Schedule of Benefits (July 1, 2026), Integumentary System Surgical Procedures, Skin and Subcutaneous Tissue, page M3.

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