Robotic Assisted Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans

Overview

The Health Care Common Procedure Coding System (HCPCS) code S2900 (Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)) describes a computer-aided tool used in performing a specific surgical procedure. UnitedHealthcare considers S2900 not separately reimbursable. 

Policy Codes

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  • S2900
* COMM-Robotic-Assisted-Surgery-Policy.pdf
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Reimbursement Guidelines

According to the Centers for Medicare and Medicaid Services (CMS), medical and surgical procedures should be reported with the Current Procedural Terminology (CPT®)/HCPCS codes that most comprehensively describe the services performed.

UnitedHealthcare considers S2900, (Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)) to be a technique integral to the primary surgical procedure and not a separately reimbursed service. When a surgical procedure is performed using code S2900, reimbursement will be considered included as part of the primary surgical procedure.

Use of Modifier 22 (increased procedural services) appended to the primary surgical procedure is not appropriate if used exclusively for the purpose of reporting the use of robotic assistance. Modifier 22 may only be used when substantial additional work is performed, (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, and physical and mental effort required) that is unrelated to robotic assistance. Documentation must demonstrate the reason for the substantial additional work performed during the surgical procedure.  See the UnitedHealthcare Increased Procedural Services Reimbursement Policy for additional information on modifier 22.