What is OHIP billing code S342?

S342 is "Epigastric hernia repair", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S342 pay?

The current OHIP fee for S342 is $239.20, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill S342 to OHIP?

S342 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S342 claims against the Schedule of Benefits rules before submission.

What codes are related to S342?

Codes related to S342 in the Schedule of Benefits include S348, S349, S346, S347, S343.

All codes

S342

S342 – Epigastric hernia repair

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

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Surgical procedure for the repair of an epigastric hernia. This service is listed in the Schedule under the 'Digestive System Surgical Procedures' section. The surgeon's fee (suffix A) is a flat rate, while fees for an assistant (suffix B) and anaesthetist (suffix C) are calculated based on basic and time units when their services are required.

When to Use

Use S342 specifically for the primary repair of an epigastric hernia, which is a defect in the linea alba between the xiphoid process and the umbilicus.
Use S342 when the procedure involves simple closure or mesh repair of an epigastric hernia, distinguishing it from more complex abdominal wall reconstructions or incisional hernia repairs (S348/S349).

Common Pitfalls

Billing S342 alongside an umbilical hernia repair (S343) without proper documentation of separate incisions or distinct anatomical defects, which may trigger a rejection for unbundling.
Attempting to bill a second surgical assistant for S342, as it is not an approved procedure for a second assistant; this requires prior authorization and a letter of justification to the Ministry.
Confusing S342 with S346 or S347, which are reserved for femoral or inguinal hernia repairs; ensure the anatomical location matches the code definition to avoid audit recovery.

Billing Tips

Always verify if the patient qualifies for age-based premiums (e.g., AGE_PREMIUM_UNDER_16_YEARS) or non-elective after-hours premiums (E409A/E410A) to maximize the surgeon's fee, as these apply directly to the S342 base rate.

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Provider Fee$239.20

Surgical Assistant Fee$75.06

Anaesthetist Fee$92.94

Non-Anaesthetist Fee$92.94

Effective: April 1, 2025

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