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Error code

S3 — Second surgical procedure allowed at 85%

Second procedure paid at 85%

This was a second procedure under the same anaesthetic, or within 14 days in the same stay for the same condition, so 85% was paid.

What to do: Check the higher-value procedure was paid in full; if so, nothing to fix.

Code
S3
Description
Second surgical procedure allowed at 85%

Explanation

Updated October 26, 2026

S3 means OHIP paid this procedure at 85% because it was a second procedure under the same anaesthetic or stay for the same condition. This is normally correct.

What it means

S3 means the line was paid at 85% of the listed fee because it was a second (or later) surgical procedure. The claim was paid; it was not rejected.

Under the Surgical Preamble, when a surgeon does more than one procedure under the same anaesthesia, or within 14 days in the same hospital stay for the same condition, the major procedure is paid in full and the others at 85% of their listed fees, unless the Schedule says otherwise. This applies to staged and bilateral procedures too. No claim should be made for a normal appendix or a simple ovarian or para-ovarian cyst removed incidentally during an operation (SP2).

Some situations are paid in full instead. A later operation needed because of a complication, or for a new condition, is paid at the full fee for each procedure (SP2). Two surgeons doing different procedures for different conditions under the same anaesthetic each get 100% (SP3). Multiple or bilateral Z-code procedures (independent operative procedures) are claimed at their full procedural fees (SP4). An elective procedure for a different condition within 14 days in the same stay by the same surgeon has the lesser procedure reduced by 15% (SP3).

Common causes

  • Two or more procedures done by the same surgeon under one anaesthetic (expected)
  • Staged procedures within 14 days in the same admission for the same condition (expected)
  • The lower-value procedure listed as the major one, so the wrong code was reduced

How to fix it

  1. Check which procedure OHIP paid in full and which at 85%.
  2. If the higher-value procedure was paid in full and the other at 85%, the payment follows the rule. There is nothing to fix.
  3. If OHIP reduced the higher-value procedure instead, or the second procedure should be paid in full (a complication, a new condition, a second surgeon, or Z-code procedures), send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with the operative note.
  4. For bilateral procedures, check S1 or S2 lines on the same claim; those follow the bilateral rules.

Don't resubmit if

  • The 85% is the multiple-procedure rule working as intended.
  • The claim was paid on the RA. Disputes go through an RAI, not a new claim.

How APEX handles it

APEX has no correction rule for S3 and doesn't send inquiries for it. It doesn't treat the 85% as expected, so on a claim with other fee codes the reduced line is marked Underpaid; on a one-code claim it shows as Settled. Check it against the rule before acting. See how APEX works · Pricing

Related codes: S1, S2, S4, S6, D2

Sources