What is OHIP billing code S465?

S465 is "Immediate repair of traumatic rupture or transection - upper 2/3", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S465 pay?

The current OHIP fee for S465 is $409.10, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill S465 to OHIP?

S465 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S465 claims against the Schedule of Benefits rules before submission.

What codes are related to S465?

Codes related to S465 in the Schedule of Benefits include S466, S467, S468, S460, S427.

All codes

S465

S465 – Immediate repair of traumatic rupture or transection - upper 2/3

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

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This surgical procedure involves the immediate suture repair of a traumatic rupture, or a partial or complete transection, located in the upper two-thirds of the ureter.

When to Use

Use S465 for the primary repair of a traumatic ureteral rupture or transection specifically located in the upper two-thirds of the ureter.
Use this code for immediate surgical intervention following penetrating or blunt trauma where the ureteral integrity is compromised in the proximal or mid-ureter.
Do not use S465 for injuries to the distal third of the ureter; use S466 for those specific anatomical locations.

Common Pitfalls

Billing S465 for elective ureteral reconstructions or non-traumatic ureteral repairs, which are not covered under this traumatic injury code.
Failing to document the specific anatomical location of the rupture, as the distinction between upper two-thirds (S465) and lower third (S466) is strictly enforced for audit purposes.
Attempting to bill S465 alongside other ureteral procedures performed during the same session without checking for global period or bundling restrictions.

Billing Tips

If the patient meets the clinical criteria for a major trauma, ensure the E420 trauma premium is submitted on the same claim to receive the 50% increase.
Always verify the Injury Severity Score (ISS) is clearly documented in the operative report to support the E420 premium, as this is a primary target for post-payment review.

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Provider Fee$409.10

Surgical Assistant Fee$77.46

Anaesthetist Fee$95.76

Non-Anaesthetist Fee$95.76

Effective: April 1, 2026

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