What is OHIP billing code S005?

S005 is "Composite resection of lesion of oral cavity and/or oropharynx with partial resection of mandible", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S005 pay?

The current OHIP fee for S005 is $1030.70, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill S005 to OHIP?

S005 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S005 claims against the Schedule of Benefits rules before submission.

What codes are related to S005?

Codes related to S005 in the Schedule of Benefits include S003, S006, S007, R990.

All codes

S005

S005 – Composite resection of lesion of oral cavity and/or oropharynx with partial resection of mandible

OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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Composite resection of a lesion of the oral cavity and/or oropharynx with partial resection of mandible. The oral cavity and pharynx includes the nasopharynx, oropharynx, and hypopharynx unless otherwise specified.

When to Use

Use S005 when performing a composite resection of an oral cavity or oropharyngeal lesion that specifically necessitates a partial mandibulectomy.
Select S005 for complex oncological resections where the surgical plan includes both the primary tumor site and the associated mandibular bone involvement.

Common Pitfalls

Do not bill S005 in conjunction with S003 or S006, as these are considered inclusive of the primary resection and would be flagged as unbundling.
Failure to document the specific extent of the mandibular resection can lead to audit recovery if the procedure is later reclassified as a simpler local excision.
Avoid billing S005 for simple biopsies or minor mucosal excisions that do not involve the mandible; these should be billed under appropriate minor surgical codes.

Billing Tips

S005 is explicitly eligible for a second surgical assistant without prior authorization; ensure both assistants are clearly identified on the claim to avoid rejection.
If the procedure is performed as a non-elective case, ensure the appropriate Special Visit Premium (e.g., C999B) is linked to the claim to capture the travel and urgency components.

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Provider Fee$1,030.70

Surgical Assistant Fee$125.10

Anaesthetist Fee$185.88

Non-Anaesthetist Fee$185.88

Effective: April 1, 2025

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