What is OHIP billing code S423?

S423 is "Partial or Heminephrectomy with Total Ureterectomy", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S423 pay?

The current OHIP fee for S423 is $757.85, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill S423 to OHIP?

S423 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S423 claims against the Schedule of Benefits rules before submission.

What codes are related to S423?

Codes related to S423 in the Schedule of Benefits include S411, S420.

All codes

S423

S423 – Partial or Heminephrectomy with Total Ureterectomy

OHIP Urology Code — Kidney and Upper Urinary Tract · Schedule of Benefits

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Partial or heminephrectomy with total ureterectomy is a surgical procedure for the excision of a portion of the kidney (heminephrectomy) combined with the total removal of the corresponding ureter.

When to Use

Use S423 when performing a formal heminephrectomy for a duplex kidney system that necessitates the concurrent removal of the entire corresponding ureter.
Use S423 for cases of urothelial malignancy involving the upper tract where a partial nephrectomy is oncologically sufficient but the entire ureter must be excised due to distal disease.

Common Pitfalls

Do not bill S423 in conjunction with S411 or S420; the procedure is inclusive of the renal resection and ureterectomy, and unbundling will trigger a rejection.
Failure to document the specific anatomical indication for the total ureterectomy (e.g., distal ureteral pathology) can lead to audit scrutiny regarding the necessity of the full ureteral excision versus a partial ureterectomy.
Attempting to bill a second surgical assistant without prior authorization will result in automatic rejection, as S423 is not on the pre-approved list for multiple assistants.

Billing Tips

If the procedure is performed as a repeat surgery at least 30 days after a previous kidney procedure, ensure code E752 is added to the claim to capture the $83.25 flat fee increase.
Always verify the patient's age at the time of the procedure to ensure the appropriate age-based percentage premium (ranging from 10% to 30%) is applied, as this is a surgical procedure eligible for these modifiers.

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Provider Fee$757.85

Specialist Fee$0.00

Surgical Assistant Fee$87.57

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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