What is OHIP billing code S323?

S323 is "Inguinal and/or femoral hernia repair - adolescents and adults", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S323 pay?

The current OHIP fee for S323 is $357.80, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill S323 to OHIP?

S323 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S323 claims against the Schedule of Benefits rules before submission.

What codes are related to S323?

Codes related to S323 in the Schedule of Benefits include S322, S326, E725, S328, S329, S330, S345, E726.

All codes

S323

S323 – Inguinal and/or femoral hernia repair - adolescents and adults

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

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Performs a unilateral repair of an inguinal and/or femoral hernia on an adolescent (16 or 17 years of age) or adult (18 years of age and older). This procedure is distinct from codes for infants (S322), children (S326), or strangulated/incarcerated hernias (S329, S330). Payment for this service includes all common and constituent elements of an insured service as defined in the Schedule of Benefits on pages -.

When to Use

Use S323 for elective, non-strangulated, unilateral inguinal or femoral hernia repairs in patients aged 16 and older.
Use S323 as the base code when performing a repair on a recurrent hernia, subsequently adding E725 to the claim.
Use S323 for repeat recurrent inguinal hernias (more than two previous repairs) by appending E726 to the primary S323 claim.

Common Pitfalls

Do not use S323 for strangulated or incarcerated hernias; these require S329 or S330, which carry different fee structures.
Avoid billing S323 for pediatric patients under 16; use S326 for children or S322 for infants to avoid automatic claim rejection.
Failure to document the specific history of prior repairs when claiming E726 will lead to audit recovery, as this code is strictly limited to patients with more than two previous repairs.

Billing Tips

Always verify if the procedure qualifies as non-elective to determine eligibility for the E409 after-hours premium, which provides a 50% increase on the S323 fee.
Ensure the assistant and anaesthesiologist fees are calculated using the specific basic unit values (6 and 7 units respectively) plus time units, rather than relying on flat-rate assumptions.

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Provider Fee$357.80

Surgical Assistant Fee$75.06

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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