S573 – Circumcision - for patients aged one year or older
OHIP Urology Code — MALE GENITAL SURGICAL PROCEDURES · Schedule of Benefits
Surgical excision of the prepuce (circumcision) for patients aged one year or older. This service is insured only when medically necessary for physical symptomatology, as detailed in the notes on page of the Schedule.
When to Use
- Use S573 for patients aged one year or older presenting with documented pathological phimosis resulting in recurrent balanoposthitis or urinary obstruction.
- Use this code for medically necessary surgical intervention following the failure of conservative management for chronic, symptomatic lichen sclerosus (balanitis xerotica obliterans).
Common Pitfalls
- Claims for S573 are frequently rejected if the clinical record lacks explicit documentation of physical symptomatology, as ritual or cosmetic procedures are strictly non-insured.
- Billing S573 for neonatal phimosis is a common error; this condition is explicitly excluded from coverage under the Schedule of Benefits.
- Failure to document the specific medical indication (e.g., recurrent infection, obstructive voiding) in the claim notes often leads to automatic audit flags.
Billing Tips
- Ensure the diagnosis code submitted reflects the underlying physical pathology (e.g., phimosis or lichen sclerosus) rather than a generic procedure code to support medical necessity.
- Always verify the patient's age at the time of the procedure to correctly apply the appropriate age-based premium (e.g., AGE_PREMIUM_UNDER_2, AGE_PREMIUM_UNDER_5, or AGE_PREMIUM_UNDER_16) to maximize the procedural fee.
Effective: April 1, 2026
U. Male Genital Surgical Procedures
MALE GENITAL SURGICAL PROCEDURES
Surgical
Male Genital Surgical Procedures
For patients aged one year or older
1. Circumcision is an insured service only when medically necessary. As such, circumcision performed for ritual, cultural, religious or cosmetic reasons at any age is not an insured service.
2. Circumcision for neonatal phimosis is not an insured service.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.