In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.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.
For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Computer-assisted (robotic) surgical systems.[FDA Web site]. 11/8/2013. Available at:
http://www.fda.gov/medicaldevices/productsandmedicalprocedures/surgeryandlifesupport/computerassistedroboticsurgicalsystems/default.htm. Accessed November 8, 2013.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. ZEUS® Robotic Surgical System. 510(k) summary. [FDA Web site]. 10/5/01. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf/K003431.pdf. Accessed November 8, 2013.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Intuitive Surgical® da Vinci. 510(k) summary. [FDA Web site]. 12/16/09. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf9/K090993.pdf. Accessed November 8, 2013.
Not eligible for separate reimbursement
S2900 Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)