What is OHIP billing code S491?

S491 is "Plastic repair of extrophy using bladder and including skin flaps", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S491 pay?

The current OHIP fee for S491 is $703.85, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill S491 to OHIP?

S491 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S491 claims against the Schedule of Benefits rules before submission.

What codes are related to S491?

Codes related to S491 in the Schedule of Benefits include S488.

All codes

S491

S491 – Plastic repair of extrophy using bladder and including skin flaps

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

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Plastic repair of extrophy using bladder and including skin flaps. This surgical procedure is eligible for assistant services with 6 basic units (, ) and anaesthesia services with 6 basic units (, ). Time units for both assistant and anaesthetist services are calculated as per the rules outlined in the General Preamble. See and for time unit calculations.

When to Use

Use S491 for the definitive plastic repair of bladder exstrophy where the procedure explicitly involves the use of bladder tissue and the mobilization of skin flaps for closure.
Select S491 over S488 when the surgical technique specifically requires the utilization of skin flaps to achieve coverage or reconstruction, as S491 is the more comprehensive code for this specific reconstruction.

Common Pitfalls

Failure to document the specific use of skin flaps in the operative report, which is a mandatory requirement for the validity of the S491 code.
Incorrectly billing S491 alongside other urogenital reconstruction codes without ensuring the procedures are distinct and not considered 'included' in the global fee for bladder exstrophy repair.

Billing Tips

Ensure that the surgical assistant and anaesthetist time units are calculated precisely based on the start and end times documented in the anaesthesia record, as these are subject to strict audit against the 6 basic units provided for S491.
If the patient is under 16 years of age, verify if the procedure qualifies for the age-based fee premium (e.g., AGE_PREMIUM_5Y_16Y) and ensure it is appended correctly to the claim to maximize the procedural fee.

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Provider Fee$703.85

Surgical Assistant Fee$77.46

Anaesthetist Fee$95.76

Non-Anaesthetist Fee$95.76

Effective: April 1, 2026

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