OHIP Remittance Advice code S4

Procedure fee reduced when paid with related surgery or anaesthetic

Ontario Ministry of Health, Remittance Advice Explanatory Codes

Where you’ll see it

On your Remittance Advice. The claim was assessed, and this explanatory code says how it was paid, reduced or refused. The Remittance Advice arrives monthly, in the first week.

Nothing is wrong with the claim

This code explains how OHIP priced the line under a Schedule of Benefits rule. It usually appears beside a partial payment. There is nothing to correct. Check it only if the amount looks lower than you expected.

If the payment still looks wrong after reading the rule, you can ask OHIP to review it with a Remittance Advice Inquiry (RAI).

Our summary is a guide, not a ruling. The ministry’s wording and the current Schedule of Benefits are what OHIP applies. See OHIP Error Report vs Remittance Advice: reading the codes for how the two reports differ.

Related Remittance Advice codes

• O1 · Fee for obstetric care apportioned
• S1 · Bilateral surgery, one stage, allowed at 85% higher than unilateral
• S2 · Bilateral surgery, two stage, allowed at 85% higher than unilateral
• S3 · Second surgical procedure allowed at 85%
• T1 · Fee allowed according to surgery claim
• V8 · This service paid at lower fee as per stated OHIP policy