ModifiedUnitedHealthcarePolicy CS167LA.C

Computer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Louisiana Only)

Defines UnitedHealthcare medical policy for computer-assisted surgical navigation (CAN) in musculoskeletal procedures of the pelvis and appendicular skeleton, specifying coverage stance and applicability to Louisiana.

Policy Summary

PayerUnitedHealthcare

PolicyComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Louisiana Only)

Policy CodePolicy CS167LA.C

Change TypeRevised coverage language and reimbursement clarification

Effective DateMar 1, 2025

Next Review DateN/A

Key ActionVerify federal, state, and plan-specific prior authorization rules before delivering or billing for CAN or intra-operative sensor use.

SourceLink

POLICY UPDATE CHANGES

Replaced language to state that the use of an intra-operative sensor for implant stability during knee replacement arthroplasty and for improved knee function post-operatively is unproven and not medically necessary.

Revised description for CPT code 27599.

Clarified that intra-operative use of a sensor for implant stability during knee replacement arthroplasty is incidental to the primary procedure and not eligible for separate reimbursement.

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

Louisiana-onlystate applicability

CS167LA.Cdocument identifier

Pelvis & appendicular

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.

Coverage Criteria and Rationale

Not medically necessary — general

Covered when ALL of the following are met:

Main coverage stance: Computer-assisted surgical navigation (CAN) for musculoskeletal procedures of the pelvis and appendicular skeleton is unproven and not medically necessary due to insufficient evidence of efficacy.

Policy applies to Louisiana; see clinical evidence sections for joint-specific summaries.

Reimbursement implication: 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.

See Coding and Documentation sections for referenced procedure codes and billing guidance.

Coverage rationale

Summary of coverage stance and supporting evidence:

CAN for pelvis/appendicular indications: Computer-assisted navigation may improve procedural precision (for example, bone cutting and implant alignment) in hip and knee and other appendicular skeletal procedures, but the evidence is inconsistent and insufficient to demonstrate improved patient-centered clinical outcomes; additional controlled studies measuring health outcomes are needed.

Evidence is preliminary for upper extremity and spine; CAN commonly increases operative time without consistent improvements in complications, revisions, or functional outcomes.

TKA intra-operative sensors: The use of an intra-operative sensor for implant stability during total knee arthroplasty (TKA) and for improved post-operative knee function is unproven and not medically necessary due to insufficient evidence of improved clinical outcomes despite improvements in intraoperative balance measures.

Systematic reviews and RCTs report improved radiographic/alignment or intraoperative balance metrics but no consistent improvement in patient-reported outcomes or long-term function; policy language was revised to explicitly include post-operative function.

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.

Policy language was revised to clarify reimbursement: claims for intra-operative sensor use during knee replacement are regarded as incidental to the primary arthroplasty and therefore not separately reimbursable. Prior wording was replaced to generalize this stance and align the incidental/reimbursement clarification with current coverage rationale.

Computer-assisted navigation (CAN) for musculoskeletal procedures of the pelvis and appendicular skeleton, including intra-operative sensors used during knee arthroplasty, is considered unproven and not medically necessary because available evidence does not demonstrate consistent patient-centered outcome benefits despite some improvements in radiographic alignment and precision.

The use of an intra-operative sensor to assess implant stability during knee replacement arthroplasty and the use of such sensors to achieve improved post-operative knee function is unproven and not medically necessary. Controlled trials and meta-analyses show improved intraoperative balance measures or reductions in certain procedures (for example, manipulation under anesthesia) but do not demonstrate consistent improvements in functional outcomes or patient-reported satisfaction.

Procedure Codes and Device Coding

Referenced procedure codesCPT

0054T	Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images (List separately in addition to code for primary procedure).
*0054T	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).
61781	CPT for cranial procedures (referenced for cranial/spinal procedures).
61782	CPT for cranial procedures (referenced for cranial/spinal procedures).
61783	CPT for cranial procedures (referenced for cranial/spinal procedures).

FDA cleared devices (informational)mixed

	Digimatch Orthodoc Robodoc Encore Surgical System
	ExactechGPS
	iASSIST Knee System
	JointPoint
	Intellijointe Navigation System (Hip and Knee)
	KneeAlign
	NuVasive Pulse System
	NuVasive Next Generation NVMS System
	OrthAlign Plus System
	Stryker OrthoMap Versatile Hip System

1–10 of 14

1/2

Provider Guidance, Billing, and Prior Authorization

Note

Coding and documentation note

Referenced procedure codes are for informational purposes only. Inclusion of codes below does not guarantee coverage or reimbursement; check applicable federal, state, and contractual rules.

Codes are reference-only and may not be all-inclusive
Listing of a code does not imply the service is covered or not covered
Check benefit plan, federal, state, or contractual requirements for coverage

Denial Risk

Reimbursement denial risk for separate billing

Intra-operative sensors (including kinetic balance sensors) are considered incidental to primary knee arthroplasty procedures. Separate billing for these sensors is not eligible for reimbursement and carries a high risk of claim denial.

Affected codes: CPT 27599 (unlisted procedure, femur or knee) when billed separately for a sensor
Provider action: Do not bill separately for intra-operative implant-stability sensors during total knee arthroplasty (TKA)

Background and Evidence Summary

Computer-assisted navigation (CAN) comprises computer-enabled tracking systems—image-based or imageless—that aid alignment and implant positioning in orthopedic procedures. CAN workflows typically include registration (mapping imaging or anatomy to the surgical field), data acquisition (CT, MRI, fluoroscopy, or imageless methods), and tracking (optical or electromagnetic trackers). CAN may improve radiographic alignment but the evidence does not consistently show improved clinical or functional outcomes, and CAN is often associated with longer operative times and additional planning or radiation exposure depending on the system.

Terms and Definitions

Appendicular Skeleton System definition

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

Anatomic scope in policyApplies to pelvis and appendicular skeleton (excludes cranial/spinal indications in this policy).

Clinical relevanceCAN investigations have primarily focused on knee and hip procedures within the appendicular skeleton; evidence for upper extremity is preliminary.

Sensor definition

DefinitionAn electronic device that measures physical properties (e.g., temperature, pressure, distance, speed, torque, acceleration, force, flow) and sends the information to an electronic processor.

Intraoperative useSmart sensors can provide objective assessment of ligament and soft tissue balancing during total knee arthroplasty and help achieve desired kinematic targets.