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M054
M054 – Intranasal maxillary antrostomy
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
A unilateral surgical procedure to perform an intranasal maxillary antrostomy using either an endoscopic or endonasal approach. This involves creating an opening (antrostomy) into the maxillary sinus through the nasal passage to improve drainage and ventilation. The surgical fee includes pre-operative and post-operative care as outlined in the Surgical Preamble ().
When to Use
- Use M054 for a standalone, unilateral intranasal maxillary antrostomy performed endoscopically or endonasally when no other sinus work (such as ethmoidectomy) is required.
- Use this code for revision cases where only the maxillary antrostomy needs to be enlarged or cleared, provided it is not bundled into a more comprehensive procedure like M083.
Common Pitfalls
- Billing M054 alongside M083 is a common rejection; M083 is an inclusive code that already covers the maxillary antrostomy, rendering M054 ineligible.
- Failing to apply the 85% rule for secondary procedures when performing M054 in conjunction with other non-inclusive surgical procedures during the same operative session.
Billing Tips
- Ensure the operative report clearly specifies the unilateral nature of the procedure, as M054 is a unilateral code; bilateral procedures require the appropriate bilateral indicator or submission as two separate claims if allowed by the Schedule.
Provider Fee$123.70
Surgical Assistant Fee$75.06
Anaesthetist Fee$154.90
Non-Anaesthetist Fee$154.90
Effective: April 1, 2025
Category
P. Respiratory Surgical Procedures
Subcategory
RESPIRATORY SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Respiratory Surgical Procedures
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