Modifiedsierra health and lifePolicy 2026T0599L

Computer-Assisted Surgical Navigation for Musculoskeletal Procedures

Defines UnitedHealthcare's coverage stance for computer-assisted surgical navigation (CAN/CAS) and intra-operative implant sensors for musculoskeletal procedures for Commercial and Individual Exchange plans.

Policy Summary

Payersierra health and life

PolicyComputer-Assisted Surgical Navigation for Musculoskeletal Procedures

Policy CodePolicy 2026T0599L

Change TypeRevised clinical evidence and references

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionDo not bill separately for intraoperative implant sensors for knee arthroplasty; treat as incidental to the primary procedure and follow member-specific benefit rules.

SourceLink

POLICY UPDATE CHANGES

Updated Description of Services, Clinical Evidence, and References sections to reflect the most current information.

Not medically necessaryCAN coverage stance

IncreasedOperative time

50 RCTsRCTs (navigation subgroup)

4 RCTsSensor RCTs

0054T,0055T,20985,27599

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Procedure codes listed

Coverage Criteria — Clinical Determinations

Not medically necessary: CAN for pelvis and appendicular skeleton

Covered when ALL of the following are met

Primary determination: Computer-assisted surgical navigation for musculoskeletal procedures of the pelvis and appendicular skeleton is unproven and not medically necessary due to insufficient evidence of efficacy.

Policy states CAN for these indications is not medically necessary.

Not medically necessary: Intra-operative implant sensors (knee)

Sensor use during TKA: Intra-operative sensor for implant stability during knee replacement arthroplasty is unproven and not medically necessary; it is considered incidental to the primary procedure and not eligible for separate reimbursement.

Codes such as 27599 may be used for sensors but separate reimbursement is not eligible.

Coverage-relevant evidence conclusions

Summarized clinical-policy-relevant conclusions from evidence:

Radiographic alignment vs clinical outcomes: CAN generally improves radiographic/component alignment compared with conventional TKA but does not consistently improve functional outcomes or revision rates in RCTs and meta-analyses.

Supported by Sheridan 2023, Matar 2020 and other reviews.

Operative time and resource use: CAN and some sensor systems are associated with longer operative times and greater resource use compared with conventional techniques.

Sheridan et al. reported longer mean operative times with navigated TKA.

Sensor intraoperative metrics vs patient outcomes: Sensor-guided balancing reduces intraoperative imbalance metrics and some procedural endpoints but does not show consistent improvements in patient-reported functional outcomes or complication rates across trials and meta-analyses.

Based on Wood 2021 RCT and Tran 2025 and other meta-analyses.

Special populations/complex anatomy: CAS-TKA may be promising for complex cases (e.g., extra-articular deformity) with improvements reported in alignment and range of motion in nonrandomized series, but comparative RCT evidence is limited.

The musculoskeletal navigation CPT codes described in this policy are intended for pelvic and appendicular procedures and do not apply to cranial or spinal navigation. For cranial and spinal procedures, use CPT codes 61781, 61782, or 61783. Additionally, intra-operative use of a sensor for implant stability during knee replacement arthroplasty is considered incidental to the primary procedure and is not eligible for separate reimbursement under this policy.

Evidence for computer-assisted navigation (CAN) in the hip and pelvis is inconsistent: randomized controlled trials are limited and do not demonstrate clear patient‑centered benefit, leaving the effects on net health outcomes insufficiently established. CAN has been most extensively studied in the hip and knee, while literature for upper extremity (shoulder, elbow) and axial skeleton (spine) indications is very preliminary and sparse, with small trials showing trends toward improved procedural accuracy but no confirmed functional benefit. For the knee, trials and systematic reviews report that CAN typically increases operative time and show few consistent differences in clinical or functional outcomes up to 12 years post-procedure.

Overall, this policy concludes that computer-assisted surgical navigation (CAN/CAS) for musculoskeletal procedures of the pelvis and appendicular skeleton is unproven and not medically necessary due to insufficient evidence of efficacy. Similarly, the intra-operative use of implant sensors during total knee arthroplasty to assess implant stability or improve postoperative knee function is considered unproven and not medically necessary, and such sensor use is treated as incidental to the primary procedure and not eligible for separate reimbursement.

Routine adoption of intraoperative navigation for total knee arthroplasty (TKA) is not supported. The American Academy of Orthopaedic Surgeons has issued a strong recommendation against routine use of intraoperative navigation in TKA because trials show no difference in outcomes or complications. Systematic reviews and randomized trials similarly find increased operative time with CAN and no consistent improvement in patient‑reported outcomes or complication rates, so routine navigation for TKA is not recommended.

Coding and Billing Codes

Covered CPT Codes referencedCPT

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).
20985	Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to code for primary procedure).
27599	Unlisted procedure, femur or knee (e.g., sensor)

Provider Actions, Prior Authorization, and Documentation

Prior Authorization

Follow member-specific prior authorization

Follow the member-specific benefit plan document for prior authorization and coverage determinations. This policy is informational and the member-specific plan governs in the event of a conflict.

Check the member-specific benefit plan document and any applicable federal or state mandates before providing services.
When deciding coverage, the member-specific benefit plan document must be referenced; in the event of a conflict, the member-specific benefit plan governs.

Note

Device FDA clearance noted for multiple CAN and sensor systems

Surgical navigation systems and related devices generally require FDA 510(k) clearance. FDA clearance is informational only and does not by itself determine coverage.

Examples of FDA-cleared systems: ExactechGPS; iASSIST Knee System; Intellijoint Navigation System; Verasense Knee System; Stryker Navigation System; and others.
FDA clearance does not equate to coverage; use is subject to medical necessity and member benefit terms.

Background and Rationale

Computer-assisted navigation (CAN), also referred to as computer-assisted surgery (CAS), comprises intraoperative systems—either image-based (fluoroscopy, CT/MRI) or imageless—that aid surgeons in data acquisition, registration to the patient’s anatomy, and real‑time tracking of instruments using optical or electromagnetic sensors. These systems are designed to improve implant alignment and the precision of bone cuts across indications such as arthroplasty, fracture fixation, osteotomy, ligament reconstruction, and tumor resection. While CAN can improve radiographic alignment and intraoperative accuracy in some settings, the clinical benefit in terms of patient-centered outcomes has not been consistently demonstrated for pelvis and appendicular skeletal procedures.

Definitions and Terminology

Appendicular Skeleton System definition

DefinitionIncludes the bones of the shoulder girdle, the upper limbs, pelvic girdle, and the lower limbs.

Scope examplesEncompasses appendages involved in upper- and lower-limb function (shoulder, arm, forearm, hand; pelvis, thigh, leg, foot).

Clinical relevanceReferenced as the anatomic region for which computer-assisted navigation (CAN) coverage determinations apply in this policy.

Registration definition

DefinitionRelating imaging or modeled data (e.g., x‑rays, CT, MRI, or a patient’s 3‑D anatomy) to the anatomical position in the surgical field.

TechniquesMay use fiducial pins or markers or surface‑matching where preoperative image-derived bone surface models are matched to intraoperative surface points.

Policy Revision History

2026-02-01revisionLatest

Updated Description of Services, Clinical Evidence, and References sections; archived previous policy version 2026T0599K.

Policy Summary

Payersierra health and life

PolicyComputer-Assisted Surgical Navigation for Musculoskeletal Procedures

Policy CodePolicy 2026T0599L

Change TypeRevised clinical evidence and references

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionDo not bill separately for intraoperative implant sensors for knee arthroplasty; treat as incidental to the primary procedure and follow member-specific benefit rules.

SourceLink

On This Page

Evidence limited to single-arm and observational studies; RCT data lacking.

Guideline stance: AAOS Clinical Practice Guidelines provide strong evidence recommending against routine use of intraoperative navigation in TKA because there is no difference in outcomes or complications.

AAOS guideline (2016, updated 2023) states strong evidence against routine intraoperative navigation.

Denial Risk

Denial triggers — intra-operative sensor incidental to primary procedure

Intra-operative use of a sensor for implant stability during knee replacement arthroplasty is considered incidental to the primary procedure and is not eligible for separate reimbursement; this may be a denial trigger if billed separately.

Intra-operative sensor considered incidental to the primary knee arthroplasty procedure — separate reimbursement not eligible.
Denials may be triggered when the intra-operative sensor is billed separately (e.g., unlisted code 27599 or attempts to bill adjunct codes separately).

Documentation Required

No explicit procedural prior authorization or documentation requirements specified

No explicit procedural prior authorization requirements or additional documentation requirements are specified in this policy; however, clinical documentation supporting medical necessity should be submitted with claims when applicable.

Policy does not state separate procedural prior authorization rules for CAN or intra-operative sensors.
Submit clinical documentation supporting medical necessity with claims as applicable.

Prior Authorization

Check member-specific benefit

Before providing or billing for services, verify coverage and any prior authorization requirements with the member's plan; member-specific benefits and prior authorization rules may differ from standard policy language.

Check member-specific benefit plan for coverage differences and prior authorization requirements.
UnitedHealthcare may utilize tools (e.g., InterQual) and reserve the right to modify policies.

Note

Member-specific plan governs coverage conflicts

When coverage conflicts arise between this policy and the member's plan, the member-specific plan document controls.

Member-specific plan governs in the event of a conflict with this Medical Policy.
Reference the member-specific benefit plan document for final determinations.

Billing Rule

Claim documentation and coding note

Include appropriate coding and claim documentation. Listing a code in this policy does not imply coverage. Use the CPT/HCPCS coding guidance and note that some codes (e.g., 0054T, 0055T, 20985, 27599) are intended as add-on or unlisted and may be treated as incidental.

Applicable codes referenced for provider billing: 0054T, 0055T, 20985, 27599.
Listing of a code in this policy is for reference only and does not guarantee coverage.

Role in CANRegistration is the step that links acquired data to the patient to enable navigation and tracking during surgery.

Tracking definition

DefinitionSensors and measurement devices that provide real‑time feedback during surgery about orientation and relative position of tools to bone anatomy (e.g., optical or electromagnetic trackers).

ExamplesTrackers attached to surgical instruments to report tool position and orientation relative to targeted bony anatomy.

FunctionEnables intraoperative guidance and verification of instrument and implant alignment when used with CAN systems.

Computer-assisted navigation (CAN) definition

DefinitionIntraoperative systems (image‑based or imageless) that use computer‑enabled tracking to guide bone preparation and component alignment during musculoskeletal surgery.

Data sourcesMay be image‑based (preoperative CT/MRI or intraoperative fluoroscopy) or imageless (real‑time joint/kinetic and bone morphology data).

Regulatory noteMany CAN devices are cleared via FDA 510(k); FDA clearance does not by itself establish improved health outcomes or coverage.

Intraoperative sensor / sensor-guided balancing definition

DefinitionKinetic/load sensors placed intraoperatively to quantify compartmental pressures and provide objective assessment of ligament and soft‑tissue balance during total knee arthroplasty.

PurposeUsed to guide intraoperative soft‑tissue balancing decisions and may provide postimplantation monitoring data.

Evidence summaryRCTs and meta‑analyses to date show improved intraoperative balance metrics but do not consistently demonstrate improved patient‑reported functional outcomes.

Sensor-guided techniques definition

DefinitionTechniques using intraoperative load or kinetic sensors (sensor‑guided devices) to measure soft‑tissue balance during TKA and inform balancing maneuvers.

Clinical effectReduce the proportion of knees classified as unbalanced intraoperatively versus manual techniques but have not shown consistent improvements in long‑term functional outcomes.

Study examplesIncludes randomized trials such as Wood et al. (2021) and meta‑analyses (Tran 2025, Sun 2022) assessing sensor‑guided versus manual balancing.

Navigation-assisted techniques definition

DefinitionImageless navigation and computer‑assisted/navigated techniques that assist implant alignment and placement during arthroplasty using tracking and registration technologies.

ModalitiesIncludes image‑based navigation (CT/MRI/fluoroscopy) and imageless systems that rely on intraoperative anatomy mapping and trackers.

Clinical considerationsEvidence shows improved radiographic/component alignment versus conventional techniques but inconsistent translation to better patient‑reported outcomes; may increase operative time.