S542 – Posterior urethral valve
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S542 is a surgical procedure for the excision of a posterior urethral valve. This procedure is listed under the Urogenital and Urinary Surgical Procedures section of the OHIP Schedule of Benefits on page . The service is eligible for surgeon (A), assistant (B), and anaesthetist (C) fees.
When to Use
- Use S542 for the endoscopic or surgical excision/ablation of posterior urethral valves in pediatric patients.
- Use S542 when performing the primary definitive treatment for obstructive uropathy caused by congenital posterior urethral valves.
Common Pitfalls
- Do not bill S542 in conjunction with other urethral procedures unless they represent distinct, separate surgical sites, as this may trigger a claim rejection for unbundling.
- Failure to apply the mandatory age-based surgical premiums (e.g., under 30 days or under 1 year) is a common oversight that results in significant under-billing for this pediatric procedure.
Billing Tips
- Always verify the patient's exact age in days at the time of the procedure to ensure the correct percentage-based age premium is applied to the base fee of $355.60.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
As per the medical record requirements in the Health Insurance Act (see ), all insured services must be documented in the patient's medical record to establish that the service was provided, is the service for which the account is submitted, and was medically necessary.
Male
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