MA PPO

Use of a Robotic-Assisted Surgical System
ma11.057a


Policy

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.

REQUIRED DOCUMENTATION

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.

BILLING REQUIREMENTS

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.

Guidelines


Description

Robotic surgical systems allow surgeons to use robotic devices to perform minimally invasive surgical procedures that require precision and control. With robotic surgery, a three-dimensional magnification of the surgical site is obtained via a tiny camera that is inserted into the individual's body. The surgeon uses voice-activated software or remote-control technology to direct the movement of the surgical instruments as the procedure is performed with the use of robotic arms, device(s), or system(s). Robotic-assisted surgery can be used for various types of surgery, including the removal of the prostate; non-cardiac chest procedures involving the lungs, esophagus, and a blood vessel inside the chest cavity; and certain procedures involving surgical incisions into the heart, such as mitral valve repair.

References


Centers for Medicare and Medicaid Services (CMS).CMS Manual System. Pub. 100-04: Medicare Claims Processing. Transmittal 1566. Final addenda [CMS Web site]. 10/1/08. Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1566CP.pdf. Accessed November 8, 2013.

US Food and Drug Administration (FDA). Caution When Using Robotically-Assisted Surgical Devices In Women's Health Including Mastectomy And Other Cancer-Related Surgeries: FDA Safety Comunication. [FDA Web site]. 2/28/2019. Available at:
https://www.fda.gov/medical-devices/safety-communications/caution-when-using-robotically-assisted-surgical-devices-womens-health-including-mastectomy-and. Accessed September 4, 2019.

US Food and Drug Administration (FDA). Computer-Assisted Sugical Systems.[FDA Web site]. 3/13/2019. Available at:
https://www.fda.gov/medical-devices/surgery-devices/computer-assisted-surgical-systems. Accessed September 4, 2019.


Coding

CPT Procedure Code Number(s)
N/A

ICD - 10 Procedure Code Number(s)


ICD - 10 Diagnosis Code Number(s)


HCPCS Level II Code Number(s)

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

Revenue Code Number(s)



Coding and Billing Requirements



Policy History

11/4/2019
11/4/2019
ma11.057
Claim Payment Policy Bulletin
Medicare Advantage
Yes