CurrentBlue Cross Blue Shield - MainePolicy C-21008

Technology Assisted Surgical Procedures - Professional and Facility

Defines Blue Cross Blue Shield - Maine's reimbursement stance for technology assisted surgical procedures (including robotic and computer-assisted systems) for both professional and facility providers; clarifies that these technologies are considered integral to the primary surgical procedure and are not separately reimbursed unless contracts or mandates state otherwise.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyTechnology Assisted Surgical Procedures - Professional and Facility

Policy CodePolicy C-21008

Change TypeNon-material revision (renamed and coding updates)

Effective DateAug 1, 2023

Next Review DateN/A

Key ActionServices must meet authorization and medical necessity guidelines and be billed with fully supported CPT/HCPCS/revenue codes.

SourceLink

POLICY UPDATE CHANGES

Renamed policy from Robotic Assisted Surgery to Technology Assisted Surgical Procedures and updated language to include computer assisted surgical systems; added codes 0054T, 0055T, and 20985 to Related Coding.

Expanded existing facility policy to apply to both professional and facility providers and added S2900 to Related Coding previously.

S2900,0054T,0055T,20985Not reimbursable codes

Both professional & facilityApplies to

NoneExemptions

06/03/2025

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyTechnology Assisted Surgical Procedures - Professional and Facility

Policy CodePolicy C-21008

Change TypeNon-material revision (renamed and coding updates)

Effective DateAug 1, 2023

Next Review DateN/A

Key ActionServices must meet authorization and medical necessity guidelines and be billed with fully supported CPT/HCPCS/revenue codes.

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.

Coverage Position

Technology assisted surgical procedures are considered integral to the primary surgical procedure and are included in the primary surgical procedure reimbursement.

ALL of the following

Technology assisted surgical procedures consist of robotic surgical systems and computer-assisted surgical systems.
No separate or additional reimbursement will be allowed for technology assisted surgical procedures unless provider, state, or federal contracts or requirements indicate otherwise.
Reimbursement will be based on payment for the primary surgical service(s) regardless of instruments, supplies, techniques, approach, or increased operating room use.
Services must meet authorization and medical necessity guidelines and be billed with fully supported CPT/HCPCS/revenue codes.
Specific HCPCS/CPT codes listed as not reimbursable: S2900, 0054T, 0055T, 20985.

This policy applies to both professional and facility providers.

Related Coding

Related Coding - Technology Assisted Surgical ProceduresmixedNot 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 in addition to code for primary procedure) — not reimbursable
0055T	Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with 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

Authorization and Billing Guidance

Billing Rule

Authorization, Medical Necessity, and Billing Requirements

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and to the member's state of residence; follow proper billing and submission guidelines using industry‑standard, compliant CPT/HCPCS/revenue codes and ensure claims are fully supported in the medical record. Failure to follow appropriate coding/billing guidelines or current reimbursement policies may result in claim denial, rejection, or recovery/recoupment of payment. The policy applies to both participating and nonparticipating professional providers and facilities unless otherwise noted, and may be superseded by provider, state, federal, or CMS mandates.

Use Current Procedure Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and/or revenue codes on all claim submissions.
Ensure billed services are fully supported in the medical record and/or office notes.
Be aware the policy may be superseded by provider, state, federal, or CMS contracts/requirements.

Technology Assisted Surgical Navigation / Robotic Assisted Surgery

Technology Assisted Surgical Navigation / Robotic Assisted Surgery — definition of computer/software assisted instrument control and movement through small incisions; explanatory field-style display.

DefinitionThe 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.

ScopeIncludes computer-assisted surgical systems; robotic assisted surgery is one type used for pre-operative planning, surgical navigation, and surgical procedure performance.

Use CasesApplied to pre-operative planning, intraoperative surgical navigation, and performance of surgical procedures via minimally invasive incisions.

Reimbursement ImplicationThese technologies are considered integral to the primary surgical procedure and are included in primary procedure reimbursement (no separate reimbursement unless contracts or mandates specify).