What is OHIP billing code S536?

S536 is "Caruncle", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S536 pay?

The current OHIP fee for S536 is $127.35, effective 2026-04-01, per the Ontario Schedule of Benefits.

How do I bill S536 to OHIP?

S536 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S536 claims against the Schedule of Benefits rules before submission.

All codes

S536

S536 – Caruncle

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

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Excision of a urethral caruncle. This is a surgical procedure and is eligible for payment to the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) when medically necessary. The surgeon's fee is listed in the Schedule. Fees for assistant and anaesthetist services are calculated based on base units plus time units. - Assistant (Suffix B): The service is eligible for 6 base units. Time is calculated in 15-minute increments as per the rules on . - Anaesthetist (Suffix C): The service is eligible for 6 base units. Time is calculated in 15-minute increments as per the rules on . This service includes all common elements of insured services as described in the General Preamble (, ).

When to Use

Use S536 for the surgical excision of a symptomatic urethral caruncle, typically performed in a clinical or hospital setting.
Use this code when the procedure is distinct and separate; do not use it for simple diagnostic biopsies, which may be covered under different pathology-related codes.

Common Pitfalls

Billing S536 in conjunction with a minor assessment code (like A007) on the same day is often rejected; the assessment is considered included in the surgical fee unless it is for an unrelated condition.
Failing to document the specific size or location of the caruncle can lead to audit scrutiny, as the complexity of excision can vary significantly.

Billing Tips

If the procedure is performed in an emergency department or outside of scheduled hours, ensure you append the appropriate Special Visit Premium to maximize the claim value.
Ensure the operative report clearly distinguishes the excision of the caruncle from any concurrent procedures to avoid 'unbundling' rejections.

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Provider Fee$127.35

Surgical Assistant Fee$77.46

Anaesthetist Fee$95.76

Non-Anaesthetist Fee$95.76

Effective: April 1, 2026

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