S577 – Circumcision - for infants less than one year of age
OHIP Urology Code — MALE GENITAL SURGICAL PROCEDURES · Schedule of Benefits
Performs the excision of the foreskin (circumcision) for infants less than one year of age. Payment for this service is conditional on it being medically necessary for physical symptomatology. As per the note on page of the Schedule, circumcision performed for ritual, cultural, religious, or cosmetic reasons, or for neonatal phimosis, is not an insured service.
When to Use
- Use S577 for infants under one year of age when there is documented physical symptomatology, such as recurrent balanoposthitis or documented urinary tract infections secondary to anatomical abnormalities.
- Use this code for medically necessary procedures where the clinical documentation clearly identifies a physical pathology that necessitates surgical intervention, distinguishing it from routine or elective cases.
Common Pitfalls
- Billing S577 for neonatal phimosis will result in an automatic rejection, as the Schedule of Benefits explicitly excludes this condition from insured coverage.
- Submitting claims for ritual, religious, or cosmetic circumcisions is a common cause of audit triggers and recovery, as these are non-insured services regardless of the patient's age.
- Failing to document the specific physical symptomatology in the patient's record creates a high risk of clawback, as the fee is strictly conditional on medical necessity.
Billing Tips
- Ensure you append the appropriate age-based premium (30% for infants <30 days, 25% for 30 days to <1 year) to the S577 base fee to maximize the claim value.
- Clearly document the specific physical symptoms or underlying medical condition in the claim notes to support the 'medically necessary' requirement and avoid manual review delays.
Effective: April 1, 2026
U. Male Genital Surgical Procedures
MALE GENITAL SURGICAL PROCEDURES
Surgical
Male Genital Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
Infants less than one year of age
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.
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