What is OHIP billing code S049?

S049 is "Plastic repair of duct", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S049 pay?

The current OHIP fee for S049 is $202.25, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill S049 to OHIP?

S049 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S049 claims against the Schedule of Benefits rules before submission.

All codes

S049

S049 – Plastic repair of duct

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

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S049 represents a surgical procedure for the plastic repair of a salivary duct. This service is eligible for payment to the surgeon (suffix A), an assistant (suffix B), and an anaesthesiologist (suffix C). As a surgical procedure, the fee includes all constituent and common elements of insured services, which includes but is not limited to: - The pre-operative assessment that leads to the decision to operate. - The surgical procedure itself. - Normal post-operative care. Refer to the Digestive System Surgical Procedures section () and the General Preamble (, ) for comprehensive rules and definitions.

When to Use

Use S049 for the surgical reconstruction or plastic repair of a salivary duct, such as in cases of ductal stricture or trauma repair.
Select S049 when the procedure is limited to the ductal system, distinguishing it from more extensive procedures involving the gland itself.

Common Pitfalls

Billing S049 in addition to a consultation or office visit on the same day is a common rejection, as the fee includes the pre-operative assessment leading to the surgery.
Attempting to bill S049 alongside other surgical procedures performed under the same anaesthetic without acknowledging the 'major procedure only' rule for assistant and anaesthetist units can lead to audit discrepancies.

Billing Tips

Ensure that if the procedure is performed after hours or on weekends, you append the appropriate E-series premiums (E409, E410) to the surgeon's fee to maximize the claim value.
Always document the specific anatomical site and the nature of the ductal repair to support the claim, as this is a specific surgical procedure code subject to post-payment review.

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Provider Fee$202.25

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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