S549 – Retropubic urethropexy - primary procedure
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S549 is a surgical procedure listed in the Schedule of Benefits. Payment is calculated based on basic and time units for the anaesthetist and surgical assistant. As per , payment for a second assistant is eligible for this procedure without requiring authorization from a medical consultant. All standard rules for surgical procedures, including requirements for documentation, pre- and post-operative care, apply as per the General Preamble.
When to Use
- Use S549 for a primary retropubic urethropexy (e.g., Burch procedure) performed for stress urinary incontinence.
- Use S549 when performing the primary suspension of the bladder neck via a retropubic approach, distinct from sling procedures which are billed under different codes.
Common Pitfalls
- Attempting to bill E003B for a second assistant; this code is explicitly restricted for this procedure.
- Failing to document the specific start and stop times for the surgical assistant and anaesthesiologist, which is mandatory for time-unit calculations under GP87 and GP95.
- Submitting a claim without the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium.
Billing Tips
- You may bill for a second assistant under S549 without prior medical consultant authorization, provided the necessity is documented in the operative report.
- Ensure that any applicable age-based premiums are calculated based on the patient's age at the time of the procedure to avoid claim rejections.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
For surgical assistant and anaesthesiologist services, time spent must be documented in the patient's medical record, including start and stop times if a replacement assistant or anaesthesiologist is involved (, ).
All insured services must be documented in the medical record to establish that the service was provided, is the service for which the account is submitted, and was medically necessary ().
Payment for a second assistant's services is payable without requiring special authorization.
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