M155 – Lung transplant (one lung)
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
M155 is for a single lung transplant surgery. This service includes all specific elements of a surgical procedure as outlined in the Surgical Preamble (, ), such as preparing the patient, performing the procedure, and immediate post-operative care. The surgical fee includes pre-operative care for 1-2 days before surgery and post-operative care for up to two weeks, with the exception of the first two post-operative visits and the discharge day visit which may be billed separately (, ). Note on Claims Submission for Transplant Surgery: - Transplant recipient: Submit claims using the transplant recipient's Ontario health insurance number. If the recipient is from out-of-province, use their provincial health insurance number. - Transplant donor: Submit claims using the donor's Ontario health insurance number. If the donor is from another province or country, or if the donor's Ontario health number cannot be obtained, use the recipient's Ontario health insurance number. (, )
When to Use
- Use M155 for a primary single lung transplant procedure.
- Use M155 when the surgical intervention is limited to one lung, distinguishing it from M156 which is specifically for a repeat single lung transplant.
Common Pitfalls
- Billing for routine post-operative hospital visits within the 14-day global period, excluding the two permitted post-op visits and the discharge day visit (C124).
- Attempting to bill for a second surgical assistant without prior authorization, as M155 is not on the pre-approved list for multiple assistants.
- Incorrectly billing a hospital admission assessment when it is not the specific major pre-operative visit where the decision to proceed with the transplant was finalized.
Billing Tips
- Ensure the first two post-operative visits and the discharge visit (C124) are submitted as separate line items to maximize recovery of services outside the global surgical fee.
- When performing multiple procedures during the same anesthesia, apply the 85% rule to secondary procedures while keeping M155 as the primary 100% fee item.
Effective: April 1, 2026
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Claims submission instructions for transplant surgery: For the recipient, use the recipient's health insurance number. For the donor, use the donor's health insurance number; if the donor is out-of-province or the number is unavailable, use the recipient's number. (, )
M156 is used for a repeat lung transplant (one lung).
M157 is used for donor Heart-Lung removal.
The fee for a second assistant requires authorization by a medical consultant as M155 is not on the pre-approved list. (, )
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