What is OHIP billing code S431?

S431 is "Excision of retroperitoneal tumour", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S431 pay?

The current OHIP fee for S431 is $381.60, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill S431 to OHIP?

S431 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S431 claims against the Schedule of Benefits rules before submission.

What codes are related to S431?

Codes related to S431 in the Schedule of Benefits include S432, S429.

All codes

S431

S431 – Excision of retroperitoneal tumour

OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits

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Excision of a retroperitoneal tumour. This surgical service includes all common and specific elements of surgical procedures as defined in the Schedule of Benefits. This includes pre-operative evaluation, the surgical procedure itself, and normal post-operative care. See the Surgical Assistants' Services (-) and Anaesthesiologists' Services (-) sections for details on calculating assistant and anaesthesia fees.

When to Use

Use S431 for the definitive surgical excision of a retroperitoneal mass when the procedure is the primary focus of the operation.
Select S431 when the surgical approach is specifically retroperitoneal, distinguishing it from intraperitoneal tumour resections that may fall under different organ-specific codes.

Common Pitfalls

Billing S431 alongside other organ-specific excision codes for the same anatomical space can trigger rejection for unbundling; ensure the procedure is distinct.
Assuming a second surgical assistant is automatically covered; S431 is not on the pre-approved list, and failure to obtain prior authorization via a medical consultant will result in payment denial.
Confusing S431 with biopsy-only codes; S431 is strictly for excision and requires documentation of the complete removal of the mass.

Billing Tips

If the procedure is non-elective and performed after hours, ensure the appropriate E409A or E410A premium is appended to the S431A claim to capture the 50-75% fee increase.
When requesting a second surgical assistant, submit the surgeon's letter of necessity concurrently with the claim to avoid the administrative delay of a manual review.

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Provider Fee$381.60

Surgical Assistant Fee$87.57

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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