Operating Microscope (CPT Code 69990)
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This reimbursement policy governs separate payment for CPT code 69990 (operating microscope) for providers under Moda Health and its affiliates; it applies to all provider contract statuses and all claim forms/dates.
Minor rewording on 6/10/2026 with no policy changes.
Coverage Criteria
COVERAGE CRITERIA — CPT 69990
CPT 69990 may be reimbursed separately only when ALL of the following conditions are met; additional billing rules and unit limits apply.
ALL of the following
- NCCI Procedure-To-Procedure (PTP) edits must not indicate that 69990 is bundled into another reported procedure code on the CMS NCCI PTP tables.
- When CMS/CCI guidelines for 69990 are more restrictive than AMA/CPT, follow CMS/CCI guidance.
- When CCI bundling indicates 69990 is bundled, deny payment to provider liability.
- Do not report more than one unit of 69990 per operative session (maximum 1 unit regardless of how many surgical codes are billed).
Coding and Units
| 69990 | Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) |
Provider Actions / Billing Rules
Prior authorization / billing rules for CPT 69990
Separate reimbursement for CPT 69990 is allowed only when the provider's applicable CMS fee schedule includes 69990 and the status indicator does not specify that 69990 is bundled or packaged. 69990 is also eligible only when NCCI PTP edits do not bundle 69990 into another reported procedure code; when CCI bundling indicates 69990 is bundled, the code is denied to provider liability. Do not report more than one unit of 69990 per operative session, and do not report 69990 for other magnifying devices such as loupes.
- Provider’s applicable CMS fee schedule must include 69990 and status indicator must not specify bundling or packaging. [[see citations]]
- 69990 must not be bundled per CMS NCCI Procedure‑to‑Procedure (PTP) edits; follow CMS/CCI guidance when it is more restrictive than AMA/CPT.
- When CCI bundling indicates 69990 is bundled, deny the code to provider liability.
- Limit to one unit of 69990 per operative session.
- Do not report 69990 for use of other magnifying devices (e.g., magnifying loupes).
Definitions
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