Error code
S5 — Not allowed in addition to major surgical fee
Included in surgical fee
This service isn't paid on top of a major surgical fee already paid; it's treated as part of the surgery.
What to do: Check whether the refused service is a usual component of the major procedure; if so, nothing more is payable.
- Code
- S5
- Description
- Not allowed in addition to major surgical fee
Explanation
Updated October 26, 2026
S5 means this service is not paid in addition to a major surgical fee. It is treated as part of the surgery.
What it means
Code S5 means OHIP refused this line because it is not allowed in addition to a major surgical fee already paid.
The surgical fee covers preparing the patient, the operation by any method, recovery room care and follow-up until the first post-operative visit. It also covers the generally accepted surgical components of the procedure and the repair of complications during the surgery by the same surgeon (SP1–SP2).
Common causes
- A component of the operation billed as a separate procedure
- A minor procedure done during the same operation, which is part of the major procedure
How to fix it
- Check whether the refused service is a usual component of the major procedure.
- If it is, nothing more is payable.
- If it was a separate service not usually part of the operation, the surgeon may claim it fee-for-service (SP2, paragraph 1). Send an RAI with the operative report. Send it through eSubmit, or on form 0918-84, within 7 months of the RA date.
Don't resubmit if
- The service is a usual component of the major procedure.
- The claim is already on your Remittance Advice. Use an RAI, not a new claim.
How APEX handles it
APEX reads your error reports and remittance advice from MCEDT and lists claims rejected with this code in its Correction Centre for you to correct and resubmit. See how APEX works · Pricing