CurrentKaiser PermanentePolicy N/A

Robotic-assisted surgery — separate reimbursement

Criteria governing whether Kaiser Permanente will separately reimburse for use of robotic surgical systems; applies to providers and members of Kaiser Foundation Health Plan of Washington and its Options, Inc. plan.

Policy Summary

PayerKaiser Permanente

PolicyRobotic-assisted surgery — separate reimbursement

Policy CodePolicy N/A

Change TypeNon-material revisions

Effective DateN/A

Next Review DateN/A

Key ActionDo not bill separately for listed robotic procedure codes for non-Medicare members; follow Kaiser Permanente payment policy when requesting review.

SourceLink

POLICY UPDATE CHANGES

Added retired Medicare LCD (L35008) and LCA (A57642) for non-covered services and removed statement that policy does not apply to Medicare members for clarity to reference Medicare.

Updated the Non-Medicare statement to match the Kaiser Permanente Payment Policy for Robotic Assisted Surgery.

Added Medicare LCA (A57642).

MultipleProcedures with robotic use

Not reimbursedCodes not reimbursed

Washington StateEvidence review outcome

Coverage Criteria — Separate Reimbursement

Separate reimbursement policy

Covered when ALL of the following are met:

Separate reimbursement not provided: Kaiser Permanente will not separately reimburse for the use of robotic surgical systems (non-Medicare members); listed CPT/HCPCS codes are not paid in addition to the primary procedure.

Refer to Kaiser Permanente payment policy for reimbursement clarifications.

Separate reimbursement: Kaiser Permanente will not separately reimburse for the use of robotic surgical systems for non‑Medicare members. This applies to the CPT/HCPCS codes listed in this policy and to other codes for which separate payment is requested for robotic assistance. Providers should follow the Kaiser Permanente payment policy for Robotic Assisted Surgery for any questions about billing or exceptions.

Exceptions and clarifications: refer to the Kaiser Permanente payment policy for Robotic Assisted Surgery for details on when separate payment may be considered and to the High‑End Imaging Site of Care Policy for high‑tech imaging requested for robotic‑assisted procedures.

Washington State Health Care Authority evidence review outcome: the Health Care Authority conducted procedure‑specific evidence reviews and found the evidence to be minimal in most cases. Their determination was to not pay additionally for use of the robotic device across the procedures they reviewed.

Policy Summary

PayerKaiser Permanente

PolicyRobotic-assisted surgery — separate reimbursement

Policy CodePolicy N/A

Change TypeNon-material revisions

Effective DateN/A

Next Review DateN/A

Key ActionDo not bill separately for listed robotic procedure codes for non-Medicare members; follow Kaiser Permanente payment policy when requesting review.

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.

Coding — Not Separately Reimbursed Codes

Not separately reimbursed codesCPT | HCPCSNot Covered

20985	Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less.
0054T	Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image guidance based on fluoroscopic images (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).

Code list completeness notemixed

Note	Codes may not be all-inclusive; deleted codes and codes not in effect at the time of service may not be covered.

Code list completeness note — limitations and actions

Scope of code listCodes listed may not be all-inclusive; deleted codes and codes not in effect at the time of service may not be covered.

Code sourcesCPT codes and descriptions copyrighted by the American Medical Association (AMA); HCPCS codes and descriptions copyrighted by Centers for Medicare Services (CMS).

Practical implicationProviders should verify code currency and payer payment policy before billing; some listed codes may be retired or inactive.

Last revised notePolicy last revised 07/25/2023 — revisions include Medicare LCD/LCA updates and clarifications regarding applicability to Medicare members.

Provider Actions — Billing and Documentation

Billing Rule

Separate reimbursement requirement

Separate reimbursement not allowed for Non‑Medicare members. Kaiser Permanente will not separately reimburse for the use of robotic surgical systems (including robotic/robotic‑assist procedure codes) for Non‑Medicare members. Refer to Kaiser Permanente payment policy for reimbursement clarifications.

Not separately reimbursed for Non‑Medicare members: robotic surgical system use and robotic/robotic‑assist procedure codes
See Kaiser Permanente payment policy for reimbursement details
High‑tech imaging for robotic‑assisted surgery: refer to High‑End Imaging Site of Care Policy

Documentation Required

Required documentation for review

Provider action: When requesting review, submit the last 6 months of clinical notes from the requesting provider and/or specialist. Include any operative reports, imaging reports, and documentation supporting medical necessity for the procedure.

Submit last 6 months of clinical notes from requesting provider and/or specialist
Include operative reports, imaging, and supporting medical necessity documentation

Denial Risk

Separate reimbursement denied

Billing alert: Robotic/robotic‑assist procedure codes are not separately reimbursed and may be denied when billed separately for Non‑Medicare members. Verify coverage and billing rules prior to claim submission to avoid denial.

Potential denial for separate reimbursement of robotic/robotic‑assist codes for Non‑Medicare members
Confirm coverage via member Evidence of Coverage or contact Kaiser Permanente Member Services

Note

Provider actions

Note to providers: ensure all required supporting documentation is included with authorization or claim submissions to facilitate timely review and reduce risk of denial.

Definitions

Robotic assisted surgery — key facts and definition

DefinitionRobotic assisted surgery involves use of a computerized system operated by a surgeon at a computer console connected with robotic arms to assist in laparoscopic procedures.

Clinical effectMay allow finer, more precise instrument control though procedures can take longer; laparoscopic approaches are associated with reduced postoperative pain, faster recovery, and lower infection and blood loss risk for some procedures compared with open surgery.

Regulatory historyThe da Vinci system was FDA-approved for general laparoscopic surgery in 2000; numerous other indications have since been approved.

Common proceduresUsed for procedures including prostatectomy, hysterectomy, nephrectomy, cholecystectomy, colectomy, cystectomy, fundoplication, hysterectomy, myomectomy, pancreatectomy, thyroidectomy, and many others.

Coding noteUse of robotic systems may be reported with adjunct codes (e.g., 20985, 0054T, 0055T, S2900) but Kaiser Permanente does not separately reimburse these codes for non‑Medicare members as described in the policy.

OpenPayer

Robotic-assisted surgery — separate reimbursement

Coverage Criteria — Separate Reimbursement

Coding — Not Separately Reimbursed Codes

Provider Actions — Billing and Documentation

Background

Definitions