S535 – One stage repair and may include skin grafting
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S535 is a surgical procedure listed in the Urogenital and Urinary Surgical Procedures section of the OHIP Schedule of Benefits. The fee listed is for the primary surgeon's service (suffix A). Separate calculations based on basic and time units apply for the surgical assistant (suffix B, see ) and the anaesthesiologist (suffix C, see ). This procedure may be eligible for various add-on premiums, including age-based increases (), after-hours premiums (e.g., E409, E410), and the trauma premium (E420) if specific criteria are met. This service is also eligible for a second surgical assistant without requiring special authorization.
When to Use
- Use S535 for a definitive one-stage surgical repair of a urogenital defect that incorporates a skin graft as part of the primary procedure.
- Select S535 when the procedure is a comprehensive, single-session reconstruction, distinguishing it from multi-stage procedures or simple closures that do not involve grafting.
Common Pitfalls
- Failing to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, which is a mandatory audit requirement.
- Incorrectly billing a second surgical assistant as a separate procedure code rather than using the appropriate suffix and documentation to reflect the second assistant's role.
- Attempting to claim after-hours premiums (E409/E410) in conjunction with the trauma premium (E420), as these are mutually exclusive per the General Preamble.
Billing Tips
- Ensure the second surgical assistant is billed using the same code S535 with the appropriate suffix, as this procedure is pre-approved for two assistants without requiring prior authorization.
- Always verify the patient's age at the time of surgery to automatically apply the correct percentage-based age premium (GP64) to the base fee of $959.65.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
Second Assistant: S535 is a service where a second assistant's services are payable and authorization from a medical consultant is not required. The amount payable for the second assistant is calculated in the same manner as the amount payable for the first assistant.
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