R026

PDF page 573 / M23

Up to 2.5 cm
   R021 - face or neck........................................................................       6     115.60    6
   R026 - other areas .........................................................................      6      77.35    6
     2.6 cm to 5 cm
   R022 - face or neck.......................................................................        6     194.85    6
   R027 - other areas .........................................................................      6     130.10    6
     5.1 cm to 10 cm
   R023 - face or neck........................................................................       6     277.90    7
   R028 - other areas .........................................................................      6     185.60    6
     Greater than 10 cm
   R017 face or neck ............................................................................ 6 417.05 7
   R029 other areas.............................................................................. 6 288.20 7
      Note:
      1.Authorization is required for all scar revisions in areas other than the face or neck (see
        Appendix D).
         2.Revision of post-infection scarring of face must be claimed on an “I.C” basis - maximum
           payable will be as equated to R023.

PDF page 810 / AD2

APPENDIX D
SURFACE PATHOLOGY
 1. Trauma Scars
   a. Neck or Face:
      i.   Includes ears and non-hair bearing areas of the scalp.
      ii. Repair of all such scars is an insured service, except for scars resulting from previous
          surgery to alter appearance that was not originally an insured service.
      iii. Repair procedures will depend upon the lesion but may include excision, revision,
           dermabrasion, etc.
      iv. Rhytidectomy procedures for cosmetic reasons, however, are not insured services.
      v.   Prior authorization from the Ministry of Health for repair of trauma scars to the face or
           neck is not required.
   b. Scars in other Anatomical Areas
      i.   Repair of scars which interfere with function or which are significantly symptomatic
           (pain, ulceration, etc.) is an insured service.
      ii. Scars with no significant symptoms or functional interference
           •   Repair is an insured service if such a repair is part of a pre-planned post-traumatic
               (including post-surgical) staged process. Notification to the Ministry of Health must
               be included as part of the planning process.
           •   Other post-traumatic scar revision is not an insured service.
           •   Scar revision should not be claimed when excision of a scar is the method of
               gaining access to the surgical site of the major procedure.
               – Prior authorization from the Ministry of Health is required for all scar repair
                  procedures in areas other than the face or neck. Scar revision codes should be
                  used (e.g. R026-R029).
 2. Keloids
   a. Head or Neck
      i.   The repair of all such keloids is an insured service.
      ii. Repair procedures may include excision, injection, dermabrasion or planning.
      iii. Prior authorization is not required.
   b. Excision of keloids in other areas
      i.   Not an insured service unless significantly symptomatic (pain, ulceration, etc.) or there
           is functional impairment.
      ii. Prior authorization from the Ministry of Health is required.

Master, record 4288. Record Layout PDF, page 1.

R02620260401999999990000077350000000774600000000000000000095760000000957600

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.