CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

computer_assisted_navigation_in_orthopedic_procedures

Policy describes coverage and reimbursement stance for computer-assisted musculoskeletal surgical navigation used during orthopedic procedures (image-based and image-less systems, sensors like VERASENSE and iASSIST) for BlueCHiP for Medicare and Commercial products. It outlines that CAN procedures are covered services but not separately reimbursed and notes benefit variation by contract.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

Policycomputer_assisted_navigation_in_orthopedic_procedures

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJun 6, 2017

Next Review Date

Key ActionAlthough navigation codes (20985, 0054T, 0396T, 0055T, S2900) are listed as covered, providers will not be separately reimbursed for these services and should not expect separate payment beyond the primary procedure reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this update.

5Navigation/related codes listed

0Codes separately reimbursed

Coverage Summary

This policy covers the use of computer-assisted musculoskeletal surgical navigation (CAN) during orthopedic procedures for BlueCHiP for Medicare and Commercial products and is designated as covered with criteria. The policy is effective 06/06/2017 and was last reviewed on 04/03/2018. Navigation-related procedure codes (for example, 20985, 0054T, 0396T, 0055T, S2900) are listed as covered but are not separately reimbursed and should not be billed for separate payment beyond the primary procedure reimbursement.

Medical Necessity / Coverage Criteria

Coverage statement

Covered when the service is provided as part of an orthopedic surgical procedure; no separate reimbursement:

ALL of the following

Computer-assisted musculoskeletal surgical navigational orthopedic procedures are covered services
Providers will not be separately reimbursed for the services (navigation codes are listed but not paid separately)
Benefits may vary between groups/contracts; refer to Evidence of Coverage, Subscriber Agreement, or Benefit Booklet for limitations

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Codes

Listed navigation/related procedure codes (covered but not separately reimbursed)CPT/HCPCS/mixedCovered

20985	Computer-assisted surgical navigational procedure for musculoskeletal procedures; image-less (List separately in addition to code for primary procedure)
0054T	Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image guidance based on fluoroscopic images (List separately in addition to code for primary procedure)
0396T	Intra-operative use of kinetic balance sensor for implant stability during knee replacement arthroplasty (List separately in addition to code for primary procedure)
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)
S2900	Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)

Provider Actions / Billing Guidance

Billing Rule

No separate reimbursement for navigation codes

Although navigation codes (20985, 0054T, 0396T, 0055T, S2900) are listed as covered, providers will not be separately reimbursed for these services and should not expect separate payment beyond the primary procedure reimbursement.

20985
0054T
0396T
0055T
S2900

Documentation Required

Benefit variation and member eligibility

Verify member-specific benefits and coverage limitations with the Evidence of Coverage, Subscriber Agreement, or Benefit Booklet prior to billing; benefits may vary by group/contract.

Background & Evidence

Computer-assisted navigation (CAN) systems—image-based or image-less—are used to increase surgical accuracy and assist with alignment, registration, and tracking across a range of orthopedic procedures including total knee arthroplasty (TKA), total hip arthroplasty (THA), fracture fixation, ligament reconstruction, osteotomy, and tumor resection. Image-based systems use preoperative CT or intraoperative fluoroscopy; non-image-based (imageless) systems acquire anatomy intraoperatively and often use infrared tracking.

Devices such as VERASENSE (a single-use microprocessor sensor tibial trial that quantifies load and contact position) and iASSIST (an accelerometer-based alignment system with disposable electronics) provide intraoperative quantitative feedback and were cleared by the FDA via the 510(k) process. While CAN reduces variability in implant alignment, the evidence does not consistently show improved long-term clinical outcomes, and longer-term studies with sufficient sample size and follow-up are needed to establish effects on health outcomes.

Randomized controlled trials and comparative studies demonstrate a decrease in variability of alignment with CAN (fewer alignment outliers), but these studies have not shown consistent improvements in short- to mid-term clinical outcomes. Given low short-term revision rates with conventional procedures and limited power and follow-up in existing studies, longer-term, adequately powered studies are needed to determine whether CAN improves meaningful clinical outcomes such as function, symptoms, and revision risk.

Term	Definition
Computer-assisted navigation (CAN)	Computer-enabled tracking systems (image-based or non-image-based) that assist surgeons in alignment, registration, and tracking during orthopedic procedures.
VERASENSE	Single-use device with microprocessor sensors to quantify load and contact position in TKA; provides quantitative data on implant alignment and soft tissue balancing.
iASSIST	Accelerometer-based alignment system with disposable electronics for intraoperative alignment guidance in knee arthroplasty.