Z256 – Maxilla - bilateral
OHIP Psychiatric Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs bilateral onlay bone grafting or alloplastic reconstruction to the maxilla. This procedure is distinct from and not performed as part of a standard osteotomy. According to the commentary on page of the Schedule, alloplastic materials include high density polyethylene, titanium mesh, resorbable mesh plus composites, calcium phosphate bone cements, and other materials. Note: Services for harvesting and/or use of homogenous bone grafts may be claimed in addition (see page for appropriate listings).
When to Use
- Use Z256 for bilateral onlay bone grafting or alloplastic reconstruction of the maxilla when the procedure is performed independently of a standard osteotomy.
- Select this code when utilizing synthetic materials such as titanium mesh, high-density polyethylene, or calcium phosphate bone cements for bilateral maxillary augmentation.
Common Pitfalls
- Attempting to bill Z256 as part of a standard osteotomy procedure; the Schedule explicitly states this code is distinct and not for use in conjunction with osteotomy services.
- Failing to bill the appropriate add-on code E553 when using banked bone or bone substitutes, which is specifically permitted in addition to Z256.
- Submitting a claim for a surgical assistant directly; Z256 does not have assigned assistant units, requiring the use of M400B subject to medical consultant approval.
Billing Tips
- Always verify if the procedure involves homogenous bone graft harvesting or use, as these are separately claimable in addition to the base Z256 fee.
- When calculating anaesthesia, remember that Z256 lacks base units; you must derive the fee by referencing a comparable procedure's base units plus time units as per GP93.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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