CurrentAnthemPolicy C-21008

Technology Assisted Surgical Procedures - Professional and Facility

Defines Anthem's reimbursement stance for technology-assisted surgical procedures (robotic and computer-assisted systems) for professional and facility providers; applies to commercial lines and is governed by member benefit plans, state/federal law, and provider contracts.

Policy Summary

PayerAnthem

PolicyTechnology Assisted Surgical Procedures - Professional and Facility

Policy CodePolicy C-21008

Change TypeTitle and coding updates

Effective DateAug 1, 2023

Next Review Date

Key ActionServices must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis.

SourceLink

POLICY UPDATE CHANGES

Renamed policy title to Technology Assisted Surgical Procedures and updated language to include technology assisted surgical procedures and computer assisted surgical systems; added codes 0054T, 0055T, and 20985 to the Related Coding section.

Expanded scope from a facility-only policy to include both professional and facility providers.

0separate/additional reimbursements allowed for technology-assisted codes

4related codes listed as not reimbursable

2provider types policy applies to

2023-08-01effective date

Coverage Criteria

Covered when ALL of the following are met:

The Health Plan does not allow separate or additional reimbursement for the use of technology assisted surgical procedures unless provider, state, or federal contracts and/or requirements indicate otherwise.

Technology assisted surgical procedures (robotic and computer-assisted systems) are considered integral to the primary surgical procedure and included in the primary procedure payment; reimbursement will be based on the payment for the primary surgical service(s).

This policy applies to both professional and facility providers.

Code exclusions: The following codes are listed as not reimbursable when billed separately in addition to the primary procedure: S2900; 0054T; 0055T; 20985.

Related Codes and Reimbursement Rules

Policy Summary

PayerAnthem

PolicyTechnology Assisted Surgical Procedures - Professional and Facility

Policy CodePolicy C-21008

Change TypeTitle and coding updates

Effective DateAug 1, 2023

Next Review Date

Key ActionServices must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Related technology-assisted procedure codesHCPCS | CPTNot Covered

S2900	Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure); not reimbursable
0054T	Computer-assisted musculoskeletal surgical navigational orthopedic procedure, image-guidance based on fluoroscopic images (List separately in addition to code for primary procedure); not reimbursable
0055T	Computer-assisted musculoskeletal surgical navigational orthopedic procedure, image-guidance based on CT/MRI images (List separately in addition to code for primary procedure); not reimbursable
20985	Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to code for primary procedure); not reimbursable

Reimbursement rule — technology-assisted procedures considered integral; use payment for primary surgical service(s)

Reimbursement ruleTechnology-assisted surgical procedures are considered integral to the primary surgical procedure; reimbursement is based on payment for the primary surgical service(s) and no separate or additional reimbursement is allowed.

Scope of proceduresIncludes both robotic surgical systems and computer-assisted surgical systems (technology-assisted surgical procedures).

Provider applicabilityPolicy applies to both professional and facility providers.

ExceptionsSeparate/additional reimbursement may apply only if provider, state, or federal contracts and/or requirements indicate otherwise.

Payment basisReimbursement is based on the primary surgical service(s) regardless of instruments, supplies, techniques, approach, or increased operating room use.

OpenPayer

Technology Assisted Surgical Procedures - Professional and Facility

Coverage Criteria

Related Codes and Reimbursement Rules

Authorization and Medical Necessity

Technology Definitions