N161 – Cranioplasty, any non-autologous material
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
N161 is a surgical procedure listed in the OHIP Schedule of Benefits under 'X. Neurological Surgical Procedures', specifically for 'SKULL' repairs. Its title is 'Cranioplasty, any non-autologous material'. As a surgical procedure, it is eligible for payment to the performing surgeon (suffix 'A'), surgical assistant (suffix 'B'), and anaesthesiologist (suffix 'C'). Payment for assistant and anaesthetist services is calculated based on a combination of basic units and time units as outlined in the General Preamble (-).
When to Use
- Use N161 when performing a cranioplasty using synthetic materials like titanium mesh or polymethylmethacrylate (PMMA) to repair a skull defect.
- Select N161 specifically for non-autologous repairs; do not use this code if the procedure involves bone grafts harvested from the patient's own body, which would fall under different procedural coding.
Common Pitfalls
- Billing N161 in conjunction with other cranial procedures without ensuring the 'Multiple Procedure' rule is applied, which may lead to automatic reductions or rejections.
- Failing to document the specific type of non-autologous material used, which is a common audit trigger for verifying the appropriateness of the N161 code versus other skull repair codes.
Billing Tips
- Ensure the operative report explicitly states the material is non-autologous to justify the use of N161 over autologous bone graft procedures.
Effective: April 1, 2026
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records that establish the service was provided, is the service submitted for payment, and was medically necessary, as per .
For services rendered by a Medical Trainee, the medical record must identify the Supervising Physician, the Medical Trainee and level of training, the description of the service, patient consent, and evidence of review by the Supervising Physician. The Supervising Physician must sign off on the service. See for full details.
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