Z255 – Maxilla - unilateral
OHIP Psychiatric Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This procedure involves the unilateral application of onlay bone grafts or alloplastic materials to reconstruct the maxilla. It is specifically for cases where this is not part of a standard osteotomy. Alloplastic materials are defined as including high density polyethylene, titanium mesh, resorbable mesh plus composites, calcium phosphate bone cements and other materials. As per the Schedule of Benefits, this surgical fee includes all common elements such as arranging appointments, obtaining patient history and consent, keeping medical records, and providing follow-up care. The fee also covers usual pre-operative and post-operative care associated with the procedure.
When to Use
- Use Z255 for the unilateral placement of alloplastic materials or onlay bone grafts to the maxilla when performed as a standalone procedure.
- Select Z255 when the reconstruction is not part of a formal orthognathic osteotomy procedure, which would otherwise be billed under different codes.
Common Pitfalls
- Billing Z255 in conjunction with a standard maxillary osteotomy, as the Schedule of Benefits explicitly excludes this code when performed as part of that procedure.
- Failing to document the specific type of alloplastic material used, which is required to justify the use of this code over other reconstructive surgical codes.
Billing Tips
- Always append E553 if you are utilizing banked bone or specific bone substitutes to receive the additional flat fee payment.
- Ensure the unilateral nature of the procedure is clearly stated in the operative report to prevent rejection or audit inquiries regarding bilateral reconstruction codes.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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