CurrentBlue Cross Blue Shield - MainePolicy C-21008

Technology Assisted Surgical Procedures - Professional and Facility

Defines reimbursement stance for technology-assisted surgical procedures (robotic and computer-assisted surgical systems) for professional and facility providers under Blue Cross Blue Shield - Maine commercial plans. Applies to billing and reimbursement — identifies that these technologies are considered integral to the primary surgical procedure and are not separately reimbursed unless contract/state/federal requirements indicate otherwise.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyTechnology Assisted Surgical Procedures - Professional and Facility

Policy CodePolicy C-21008

Change TypeRevisions to title, definitions, and related coding

Effective Date08/01/2023

Next Review Date

Key ActionDo not bill technology-assisted procedure codes separately; reimbursement is based on the primary surgical procedure and requires documentation to support the billed primary service.

SourceLink

POLICY UPDATE CHANGES

Renamed policy title from 'Robotic Assisted Surgery' to 'Technology Assisted Surgical Procedures' and expanded language to include computer-assisted surgical systems; added codes 0054T, 0055T, and 20985 to Related Coding section.

Added code S2900 to Related Coding section (previously added in 06/17/2021 history).

4related HCPCS/CPT codes listed as not reimbursable/separately payable

08/01/2023policy effective date

06/03/2025

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.

Policy Snapshot

This policy, Technology Assisted Surgical Procedures - Professional and Facility, is CURRENT and defines the reimbursement stance for technology-assisted surgical procedures (robotic and computer-assisted surgical systems) for professional and facility providers under Blue Cross Blue Shield - Maine commercial plans. It applies to billing and reimbursement and identifies that these technologies are considered integral to the primary surgical procedure and are not separately reimbursed unless provider/state/federal contract terms indicate otherwise.

Document Overview

payerBlue Cross Blue Shield - Maine

policyTechnology Assisted Surgical Procedures - Professional and Facility

policy_codeC-21008

change_typeNon-material

effective_date08/01/2023

next_review_date

key_actionTechnology-assisted surgical codes considered integral; not separately reimbursed

Reimbursement Stance and Criteria

Label: billing_rules. Codes that describe technology-assisted surgical techniques, including robotic and computer-assisted navigation codes (for example, S2900, 0054T, 0055T, 20985), are considered integral to the primary surgical procedure and are not separately reimbursed. Reimbursement will be based on the payment for the primary surgical service regardless of instruments, supplies, techniques, approach, or increased operating room use. There are no exemptions noted in this policy, and reimbursement determinations remain subject to the member's benefit plan terms and any applicable state or federal mandates.

Related Coding and Billing Guidance

Related Coding - technology assisted procedures (considered integral/not separately reimbursable)mixedNot 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, with image-guidance based on fluoroscopic images (list separately) - not reimbursable
0055T	Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on CT/MRI images (list separately) - not reimbursable
20985	Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (list separately) - not reimbursable

Billing Rule

Do not bill technology-assisted procedure codes separately

Codes that describe technology-assisted surgical techniques (robotic and computer-assisted navigation) are considered integral to the primary surgical procedure and are not separately reimbursed. Reimbursement is based on the primary surgical service regardless of instruments, supplies, techniques, approach, or increased OR use.

S2900
0054T
0055T
20985

Documentation Required

Medical record support required

When billing surgical procedures, use industry-standard CPT/HCPCS codes and ensure documentation in the medical record/office notes fully supports the billed primary procedure and any techniques used. Failure to follow coding/billing guidelines may result in claim denial, rejection, or recoupment.

Authorization, Documentation & Billing Requirements

Prior Authorization

Authorization & medical necessity requirements

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and to the member's state of residence; payer or contract-specific prior authorization requirements still apply.

There are no exemptions to this policy. The policy is subject to federal and state laws and to the terms, conditions, and limitations of a member's benefits on the date of service; provider, state, or federal contracts and/or requirements may supersede this policy if they indicate otherwise.

Defined Terms

Definitions

Technology Assisted Surgical NavigationThe use of computer and software technology to control and move instruments through one or more tiny incisions in the patient's body for a variety of surgical procedures. Robotic assisted surgery is one type of computer-assisted surgical system used for pre-operative planning, surgical navigation, and procedure performance.

Policy Update History

02/22/2023 (effective 08/01/2023)revisedLatest

06/17/2021added

Initial approval and effective: expanded existing facility policy to both professional and facility providers; added S2900 to Related Coding section and updated Definitions section.

Policy updates: This policy was renamed and expanded with a revision recorded on 02/22/2023 (effective 08/01/2023) to change the title from 'Robotic Assisted Surgery' to 'Technology Assisted Surgical Procedures' and to add codes 0054T, 0055T, and 20985 to the Related Coding section. History also notes initial approval on 06/17/2021 when S2900 was added and the policy was expanded to professional and facility providers.