CurrentUnitedHealthcarePolicy CS167OH.D

Computer Assisted Surg Nav Musculoskeletal Procs Oh Cs

UnitedHealthcare Ohio medical policy CS167OH.D addressing use, coverage stance, definitions, evidence review, and coding guidance for computer-assisted surgical navigation and intra-operative sensors for musculoskeletal procedures (pelvis and appendicular skeleton), including total hip and knee arthroplasty and other appendicular indications. Applies only to Ohio Medicaid/commercial plan members as stated.

Policy Summary

PayerUnitedHealthcare

PolicyComputer Assisted Surg Nav Musculoskeletal Procs Oh Cs

Policy CodePolicy CS167OH.D

Change TypeRevised coverage & coding language

Effective DateJan 1, 2025

Next Review Date

Key ActionDo not bill separately for intra-operative use of a sensor for implant stability during knee replacement arthroplasty; it is considered incidental to the primary procedure and not eligible for separate reimbursement.

SourceLink

POLICY UPDATE CHANGES

Replaced language indicating 'the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty is unproven and not medically necessary' with '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.

Replaced notation indicating incidental use referenced 'kinetic balance sensor' with 'a sensor' for implant stability during knee replacement arthroplasty.

Archived previous policy version CS167OH.C.

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

Coverage Summary & Stance

This Ohio-specific policy (UnitedHealthcare Medical Policy CS167OH.D) applies to Ohio Medicaid and commercial plan members and addresses computer-assisted surgical navigation (CAN) and intra-operative sensors for musculoskeletal procedures of the pelvis and appendicular skeleton, including total hip and knee arthroplasty. The policy concludes that CAN and the intra-operative use of sensors for implant stability in knee arthroplasty are unproven and not medically necessary because the available evidence is insufficient to demonstrate consistent patient-centered benefits such as improved function, reduced complications, or lower revision rates.

Policy-level facts

Effective Date2025-01-01

Policy NumberCS167OH.D

ScopeUnitedHealthcare Ohio medical policy applying to computer-assisted surgical navigation and intra-operative sensors for pelvis and appendicular musculoskeletal procedures (hip, knee, other appendicular indications).

Primary Coverage StanceComputer-assisted navigation and intra-operative sensor use for implant stability during knee arthroplasty are considered unproven and not medically necessary (not covered).

State-specific NoteThis policy applies only to Ohio; medical necessity determinations reference Ohio Administrative Code 5160-101 and Ohio-specific plan requirements.

Medically Necessary / Not Medically Necessary Statements

Policy coverage statements for CAN and intra-operative sensors:

Computer-assisted navigation statement: 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.
Intra-operative sensor statement: 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 due to insufficient evidence of efficacy.

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Coverage Determination

Policy statements and coding notes as revised:

Intra-operative sensor unproven: The use of an intra-operative sensor for implant stability during knee replacement arthroplasty and for improved knee function post-operatively is considered unproven and not medically necessary.
Incidental/not separately reimbursable: Intra-operative use of a sensor for implant stability during knee replacement arthroplasty is considered incidental to the primary procedure being performed and is not eligible for separate reimbursement.

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Coding Guidance

Relevant CPT / HCPCS / Unlisted codes (reference only)mixed

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).

Cranial and spinal navigation CPT guidance (referential)CPT

61781	Cranial navigation (referenced for cranial procedures).
61782	Cranial navigation (referenced for cranial procedures).
61783	Cranial navigation (referenced for cranial procedures).

Applicable CPT Codes (not eligible for separate reimbursement when used as intra-operative sensor during knee arthroplasty)CPTNot Covered

27599

Unlisted procedure, femur or knee (description revised in policy). Do not bill separately for intra-operative use of a sensor for implant stability during knee replacement arthroplasty; considered incidental to the primary procedure and not eligible for separate reimbursement.

Coding and billing note: CPT code 27599 description was revised to “Unlisted procedure, femur or knee (e.g., sensor).” Per the policy, 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; do not bill separately for this intra-operative sensor use.

Provider Billing & Documentation Actions

Billing Rule

Intra-operative sensor considered incidental

Intra-operative use of a sensor for implant stability during knee replacement arthroplasty is considered incidental to the primary procedure being performed and is not eligible for separate reimbursement.

27599
20985
0054T
0055T

Billing Rule

Separate reimbursement ineligible

Do not bill separately for intra-operative use of a sensor for implant stability during knee replacement arthroplasty; it is considered incidental to the primary procedure and not eligible for separate reimbursement.

Background, Evidence Quality & Definitions

Background: Computer-assisted navigation (CAN) and intra-operative sensors are intended to increase surgical accuracy, guide implant positioning, and provide objective intraoperative feedback (for example, ligament/soft-tissue balancing or implant alignment) in procedures such as fracture fixation, osteotomy, and total hip and knee arthroplasty.

Evidence context: While multiple studies and systematic reviews report improved radiographic precision or component alignment with CAN and with some sensor-assisted techniques, high-quality randomized data showing consistent patient-centered outcome improvements (function, satisfaction), reductions in complications, or fewer revisions are lacking or inconclusive. Some reports also note increased operative time and inconsistent safety findings, and reviewers have judged the overall evidence insufficient to determine a net health benefit.

Clinical Area	Quality Summary
hip/pelvis CAN	insufficient; inconsistent RCTs and low-quality studies; improved implant alignment but no demonstrated patient-centered outcome benefit
TKA CAN	inconclusive for clinical outcomes; increased operative time; improved radiographic alignment but no clear functional benefit
intra-operative sensors (TKA)	lack of high-quality RCTs demonstrating improved clinical outcomes or long-term benefits

Appendicular Skeleton System: Includes the bones of the shoulder girdle, the upper limbs, pelvic girdle, and the lower limbs.

Musculoskeletal System: Made up of bones, muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports form, movement, and stability.

Incidental: Services or devices considered part of the primary procedure and not eligible for separate reimbursement.

Revision History

2025-01-01revisedLatest

Revised description for CPT code 27599 to 'Unlisted procedure, femur or knee (e.g., sensor)'.