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M056
M056 – Maxillectomy - partial or complete
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the partial or complete removal of the maxilla. The fee for this service (M056A) includes pre-operative care (1-2 days prior to surgery), the operation itself, and post-operative care for up to two weeks (excluding the first and second post-operative visits). Assistant services (M056B) are valued at 7 base units plus time units. Anaesthesia services (M056C) are valued at 10 base units plus time units. Refer to the Surgical Preamble (-) for full details on surgical billing rules.
When to Use
- Use M056 for the definitive surgical resection of the maxilla, whether partial (e.g., infrastructure maxillectomy) or complete, for malignancy or aggressive benign pathology.
- Use M056 in conjunction with E947 when the surgical plan necessitates an orbital exenteration alongside the maxillectomy for oncological clearance.
Common Pitfalls
- Billing M056 for endoscopic antrostomy or simple sinus surgery, which should be billed under M054; M056 is reserved for major maxillectomy procedures.
- Failure to apply the 15% reduction rule (SP3) when performing secondary procedures during the same hospitalization, as M056 is almost always the major procedure in a multi-procedure session.
- Attempting to bill for routine post-operative visits within the first two weeks, which are already included in the global fee for M056.
Billing Tips
- Ensure the operative report clearly distinguishes between partial and complete maxillectomy to support the claim if audited, as the complexity significantly differs.
- If performing a multi-disciplinary approach where a second surgeon performs a different procedure under the same anaesthesia, ensure the claim reflects the 100% benefit rule per SP3 to avoid incorrect automatic fee reductions.
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