CAM 090

Robotic Assisted Surgery - Reimbursement Policy

Category:Surgery   Last Reviewed:October 2019
Department(s):Medical Affairs   Next Review:October 2020
Original Date:August 2014    

Description:
Robotic Assisted Surgery is defined as the performance of operative procedures with the assistance of robotic technology. It is a method of performing the procedure, not a separate service.

Policy:
The use of robotic technology is a technique that is integral to the primary surgery being performed and, therefore, not eligible for separate reimbursement. When billed, there will be no separate or additional payment for charges associated with robotic technology. Reimbursement will be based on the payment for the standard surgical procedure(s).

Examples of charges that are not eligible for separate or additional reimbursement are listed below:

  • Increased operating room unit cost charges for the use of the robotic technology.
  • Charges billed under CPT or HCPCS codes that are specific to robotic assisted surgery, including, but not limited to, S2900.
  • Providers should NOT utilize Modifier 22: Increased Procedural Service to indicate robotic assisted surgery, as this modifier should only be used to report unusual complications or complexities that occurred during the surgical procedure that are unrelated to the use of a robotic assistance system and must be supported by documentation.

HCPCS Coding/Modifiers: 

S2900     Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)

References:

  1. Centers for Medical and Medicaid Services (CMS) Healthcare Common Procedure Coding System 9HCPCS); HCPCS Release and Code sets:  http//www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp#TopOfPage
  2. American Medical Association, Current Procedural Terminology (CPT®), Professional Edition 

This  medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

10/01/2019 

Annual review, no change to policy intent. 

10/01/2018 

Annual review, no change to policy intent. 

10/02/2017 

Annual review, no change to policy intent. 

10/03/2016 

Annual review, no change to policy. 

10/05/2015 

Annual review, no change to policy. 

10/01/2014

Corrected typo.

08/21/2014

New Policy


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