Notification



Notification Issue Date:



Medicare Advantage Policy

Title:Use of an Operating Microscope During a Surgical Procedure
Policy #:MA11.037d

This policy is applicable to the Company’s Medicare Advantage products only. Policies that are applicable to the Company’s commercial products are accessible via a separate commercial policy database.


The Company makes decisions on coverage based on the Centers for Medicare and Medicaid Services (CMS) regulations and guidance, benefit plan documents and contracts, and the member’s medical history and condition. If CMS does not have a position addressing a service, the Company makes decisions based on Company Policy Bulletins. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable. Although the Medicare Advantage Policy Bulletin is consistent with Medicare’s regulations and guidance, the Company’s payment methodology may differ from Medicare.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.


This Policy Bulletin document describes the status of CMS coverage, medical terminology, and/or benefit plan documents and contracts at the time the document was developed. This Policy Bulletin will be reviewed regularly and be updated as Medicare changes their regulations and guidance, scientific and medical literature becomes available, and/or the benefit plan documents and/or contracts are changed.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's Evidence of Coverage.

The use of an operating microscope during a surgical procedure is covered and eligible for separate reimbursement consideration by the Company to the professional provider when reported in conjunction with the primary procedure codes included in Attachment A.

When reported with any other primary procedure code, the use of an operating microscope during a surgical procedure is not eligible for separate reimbursement.
Policy Guidelines

The procedure code to report the use of an operating microscope is an add-on code and should not be reported alone.

It is not appropriate to report the use of an operating microscope when magnifying loupes or corrected vision lenses are used during a surgical procedure.

This policy is consistent with Medicare's coverage determination.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, the use of an operating microscope during a surgical procedure is covered under the medical benefits of the Company's Medicare Advantage products.

Description

An operating microscope is a two-headed magnifying device with a standard position that can be operated by hand or foot.An operating microscope is used during a specialized type of surgery known as microsurgery. Microsurgery involves magnification, microinstrumentation, microsutures, and meticulous techniques to repair or restore tissues. An operating microscope can be used for the entire surgical procedure or only for certain portions of the surgery.

An operating microscope is different from magnifying loupes, which are glasses worn during surgical procedures to facilitate vision.
References

Centers for Medicare and Medicaid Services (CMS). Medicare Claims Processing Manual. Chapter 12: Physicians/Nonphysicians practitioners. 20.4.5: Allowable adjustments (B3-15055). [CMS Web site]. 10/01/03. Available at: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf. Accessed October 15, 2006.

Townsend CM, Beauchamp RD, Evers BM, Mattox KL, Sabiston Textbook of Surgery. 16th ed. Philadelphia, PA: W.B. Saunders; 2001:1556.



Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

69990


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References

Attachment A: Use of an Operating Microscope During a Surgical Procedure






Policy History

REVISIONS FROM MA11.037d:
01/01/2019This policy has been identified and updated for the CPT code update effective 01/01/2019.

The following CPT codes have been deleted from the policy: 61332, 61480, 61610, 61612, 66220.

The following CPT narratives have been revised in this policy: 61641, 61642.

REVISIONS FROM MA11.037c:
01/01/2018This policy has been identified for the CPT code update, effective 01/01/2018.

The following CPT narratives have been revised in this policy: 76000:

REVISIONS FROM MA11.037b:
01/01/2017This policy has been identified for the CPT code update, effective 01/01/2017.

The following CPT / HCPCS code has been added to this policy: 62380

The following CPT narratives have been revised in this policy: 62287, 66740, 67101, 67105

REVISIONS FROM MA11.037a:
02/09/2015This policy has been identified for the CPT annual code update, effective 01/02/2015.

The following codes have been deleted to this policy:
61334, 61440, 61470, 61490, 61542, 61609, 64870, 66165

The following codes have been revised to this policy:
22856, 66180, 66185, 67399

The following codes have been added to this policy:
66179, 66184

REVISIONS FROM MA11.037:
01/01/2015This is a new policy.







Version Effective Date: 01/01/2019
Version Issued Date: 01/11/2019
Version Reissued Date: N/A