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: 

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 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 2024 Forward     

01/01/2024  NEW POLICY