The Company considers the use of a robotic surgical system to be an integral part of the primary surgical procedure and is, therefore, not eligible for separate reimbursement consideration whether billed alone or in conjunction with other services.
The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.
The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Procedure codes representing surgical techniques requiring the use of a robotic surgical system are add-on codes which should be reported in addition to the primary procedure; however, they are not eligible for reimbursement whether billed alone or in conjunction with other services. Participating providers may not bill members for this service.
In accordance with the Centers for Medicare and Medicaid Services (CMS), Modifier-22 (Increased Procedural Services) cannot be appended to a primary procedure code to indicate use of a robotic surgical system.