Remittance Advice · Payment-time (remittance)
OHIP explanatory code S4
Procedure fee reduced when paid with related surgery or anaesthetic
What S4 means
The Ministry of Health’s official wording for S4 is: “Procedure fee reduced when paid with related surgery or anaesthetic.”
This code appears as an explanatory code on your monthly Remittance Advice (RA). It means the claim was adjudicated — paid, reduced, or refused — for the reason below. A claim already on your RA generally shouldn't be blindly resubmitted; follow the suggested action.
How to fix S4
The fee was reduced or capped under this rule. If you believe the full amount was payable, file a Remittance Advice Inquiry with supporting detail.
Payment-time codes appear on the monthly Remittance Advice after adjudication. Some are informational, some explain a reduced or refused payment. Where you disagree with the outcome, the usual route is a Remittance Advice Inquiry or written inquiry — not resubmitting the same claim, which can create a duplicate.
Related codes
- RDDuplicate, paid in Reciprocal Medical Billing System (RMBS)
- S1Bilateral surgery, one stage, allowed at 85% higher than unilateral
- S2Bilateral surgery, two stage, allowed at 85% higher than unilateral
- S3Second surgical procedure allowed at 85%
- S5Not allowed in addition to major surgical fee
- S6Allowed as subsequent procedure-initial procedure previously claimed
- S7Normal pre-operative and post-operative care included in surgical fee
- S9Initial procedure not found
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Code meaning per Ontario Ministry of Health — Remittance Advice Explanatory Codes / Messages (March 2026). The suggested action is general information for Ontario physicians, not billing, legal, or tax advice — codes and rules change, so verify against the current Ministry of Health documents before relying on a claim.