< Billing codes

Billing code

Z516A — Colonoscopic excision of first polyp (20–29 mm)

First polyp removal, 20–29 mm

Bill for colonoscopic excision of the first polyp measuring 20 to 29 mm; additional polyps that size are E518.

Watch for: Only one first-polyp code per patient per day, chosen by the largest polyp removed.

Code

Z516A

Description

Colonoscopic excision of first polyp (20–29 mm)

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

Excision of the first polyp measuring 20 to 29 mm through the colonoscope. Additional polyps are add-on codes.

What it covers

Z516 is excision of the first polyp 20 mm to 29 mm, in the colonoscopy listings (S19). Additional polyps of this size are E518 (S19).

Smaller first polyps are Z571 (3–5 mm), Z518 (6–9 mm) and Z517 (10–19 mm). Very large sessile polyps over 3 cm are E685 (S19).

Billing rules

• Only one of Z571, Z518, Z517 or Z516 is payable per patient per day; use the largest polyp removed to choose the first-polyp code (S19).
• A maximum of 2 of E720, E520, E519 and E518, in any combination, per patient per day (S19).
• Excision of polyps under 3 mm is not payable (S19).
• No surgical assistant fee (nil) (S19).
• Z codes are independent operative procedures: if your major pre-operative visit was in the prior 12 months, only a partial assessment is payable before the procedure that day; if the major pre-operative visit is that day, no other assessment is payable before it (SP4).
• Marked #: premises, equipment, supplies and staff are funded by the hospital budget or ICHSC facility costs, and patients can't be charged for them (GP13).
• Under-16 age premiums (10–30%) apply to surgical procedures in Parts K to Z (GP64).

Often billed with

• E518 each additional 20–29 mm polyp (S19).
• E519, E520 or E720 for additional smaller polyps (S19).

Related codes: Z517, Z518, Z571, E518, E519, E685, Z496

Source: Schedule of Benefits (July 1, 2026), Digestive System Surgical Procedures, Intestines (Except Rectum), page S19.

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