CurrentCareFirstPolicy 6.01.021A

ARCHIVED Image-Guided Surgery

Describes image-guided surgery techniques (interventional and intraoperative) and states that no separate policy statement or additional benefits are provided—image guidance is considered included in the allowance for the surgical procedure. The document is archived.

Policy Summary

PayerCareFirst

PolicyARCHIVED Image-Guided Surgery

Policy CodePolicy 6.01.021A

Change TypeArchived

Effective Date

Next Review Date

Key ActionVerify coverage and contract/line-of-business terms before applying the policy because coverage varies by contract and line of business.

POLICY UPDATE CHANGES

Policy labeled as ARCHIVED and last revision date 08/01/2022.

0Separate Covered Indications

IncludedReimbursement for Image Guidance

VariesCoverage by Contract/LOB

Coverage Summary & Benefit Application

Coverage / Benefit Application

Coverage determination and benefit application for image-guided surgery:

ALL of the following

There is no separate policy statement for this Operating Procedure.
Additional benefits are not provided for the use of image guidance for surgical techniques, as this is considered included in the allowance for the surgical procedure.
Coverage will vary from contract to contract and by line of business and should be verified before applying the terms of the policy.

Provider Impact & Billing Rules

Documentation Required

Benefit Verification Required

Verify coverage and contract/line-of-business terms before applying the policy because coverage varies by contract and line of business.

Billing Rule

No Separate Reimbursement for Image Guidance

Image-guidance services are considered included in the allowance for the primary surgical procedure and are not eligible for additional benefits or separate payment under this operating procedure.

Background & Definitions

Image-guided surgery uses MR, CT, fluoroscopy, or ultrasound images processed by computer software to generate three-dimensional graphics mapped to the patient's anatomy to plan the surgical approach and track instruments. Two main techniques are described: interventional imaging (image mapping), which uses preoperative images analyzed and mapped to the patient (stereotactic frames or optical scanners/cameras) and is limited by anatomical changes during surgery; and intraoperative image-guided surgery, which uses real-time or near-real-time perioperative imaging (MR, CT, or ultrasound) mapped throughout the procedure so anatomical changes can be visualized and viable tissue preserved. Additional benefits are not provided for image guidance because it is considered included in the allowance for the surgical procedure.

Interventional imaging (image mapping): Preoperative images are analyzed with computer software and mapped to the patient (for example, using a stereotactic frame or optical scanners/cameras). This three-dimensional information may be used pre- and intraoperatively to plan the surgical approach and to track surgical instruments; it is limited as surgery progresses because preoperative images may become outdated due to anatomical changes.

Intraoperative image-guided surgery: Real-time or near-real-time perioperative images, usually taken with MR, CT, or ultrasound, are mapped to the patient throughout the surgery so that anatomical changes from the intervention can be visualized and the integrity of viable tissue can be preserved.