S554 – Fistula - penile urethra (diversion of urine extra)
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
The specific details, indications, and procedural steps for S554 are not available in the provided documentation as the target page was not supplied. However, based on its inclusion in the General Preamble (), this is a surgical procedure for which a second assistant's services are payable without prior authorization from a medical consultant, indicating a procedure of significant complexity.
When to Use
- Use S554 for the surgical repair of a fistula involving the penile urethra where urinary diversion is performed as a component of the procedure.
- Apply this code when the clinical documentation confirms the specific anatomical repair of a penile urethral fistula, distinguishing it from general urethral reconstruction codes.
Common Pitfalls
- Billing S554 without a valid referral from a physician, nurse practitioner, or dental surgeon, as this is a mandatory requirement under GP16.
- Failing to document the specific complexity of the procedure, which is a prerequisite for justifying the use of a second assistant under GP90 without prior authorization.
Billing Tips
- Ensure that if a second assistant is utilized, the claim explicitly reflects the requirement for two assistants to avoid manual review or audit triggers.
- Verify the patient's age at the time of the procedure to automatically apply the appropriate age-based percentage premium (e.g., AGE_PREMIUM_5_TO_16_YEARS) to the base fee of $98.70.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records that establish: 1) an insured service was provided; 2) the service for which the account is submitted is the service that was rendered; and 3) the service was medically necessary.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.