What is OHIP billing code S042?

S042 is "Submandibular gland or sublingual gland", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S042 pay?

The current OHIP fee for S042 is $391.05, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill S042 to OHIP?

S042 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S042 claims against the Schedule of Benefits rules before submission.

All codes

S042

S042 – Submandibular gland or sublingual gland

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

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S042 represents the surgical procedure for the excision of the submandibular gland or the sublingual gland. This service is eligible for payment for a surgeon (suffix A), assistant (suffix B with 6 base units), and anaesthetist (suffix C with 7 base units).

When to Use

Use S042 for the surgical excision of a submandibular gland due to chronic sialadenitis or obstructive sialolithiasis.
Use S042 for the excision of a sublingual gland, typically performed for the management of a ranula.
Use S042 when the procedure is performed as a standalone surgical intervention, distinct from more complex neck dissections.

Common Pitfalls

Billing a hospital admission assessment (A-code) on the same day as S042 is a common rejection; ensure you only bill the 'major pre-operative visit' if the decision to operate was made during that encounter.
Attempting to bill S042 alongside more comprehensive neck dissection codes without proper documentation of distinct, separate surgical sites can lead to audit flags for unbundling.
Failing to document the specific gland removed (submandibular vs. sublingual) can lead to confusion if the claim is reviewed, as both fall under the same fee code.

Billing Tips

If performing a bilateral excision during the same anesthetic, ensure the second procedure is billed with the appropriate bilateral indicator to avoid rejection, while noting that assistant/anaesthetist units are based on the major procedure only.
Always verify if the patient meets the criteria for age-based premiums (e.g., under 16 years) or after-hours premiums (E409/E410) to maximize the claim value, as these are frequently missed for non-elective cases.

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Provider Fee$391.05

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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