CurrentUnitedHealthcarePolicy 2024R0038A

Microsurgical technique (use of operating microscope) reimbursement

Governs reimbursement for use of an operating microscope reported with CPT codes 64727 and 69990 for UnitedHealthcare Community Plan claims billed on CMS 1500 (and when specified UB-04) and defines when those codes are payable in conjunction with specified surgical procedure codes.

Policy Summary

PayerUnitedHealthcare

PolicyMicrosurgical technique (use of operating microscope) reimbursement

Policy CodePolicy 2024R0038A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit CPT 64727 or 69990 only when billed with allowed primary procedure codes listed in the policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2primary CPT codes addressed (64727, 69990)

listsservice lists provided for each primary code

CMS alignmentpolicy follows CMS guidelines for 69990

CMS1500/UB04forms referenced

Coverage Criteria for Operating Microscope Codes

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64727 coverage rules

Covered when ALL of the following are met:

CPT 64727 will be reimbursed only when submitted with internal neurolysis codes listed in 'Services Allowed with 64727'.

'Services Allowed with 64727' includes CPT codes: 64702, 64704, 64722, 64726.

Per CMS and Correct Coding Initiative guidance, CPT 69990 is not to be reported in addition to CPT 64727.

69990 coverage rules

Covered when ALL of the following are met:

UnitedHealthcare follows CMS reimbursement guidelines for CPT 69990 and will reimburse 69990 only when billed in conjunction with services described in the 'Services Allowed with 69990' list.

'Services Allowed with 69990' consists of specified nervous system primary procedures and associated add-on mappings (examples shown in the policy).

Add-on codes may be allowed when the primary procedure is allowable per CMS guidance (UnitedHealthcare aligns with CMS on allowing 69990 with add-on codes when the primary procedure is allowed).

Per CMS/CCI, 69990 is not reportable in addition to 64727 (i.e., 69990 should not be reported with 64727).

Coding Guidance and Code Lists

CPT 64727 guidanceCPTCovered

64727	Microsurgical technique using operating microscope (reimbursed when billed with internal neurolysis codes on allowed list)
64702	Service listed in 'Services Allowed with 64727'
64704	Service listed in 'Services Allowed with 64727'
64722	Service listed in 'Services Allowed with 64727'
64726	Service listed in 'Services Allowed with 64727'

CPT 69990 guidanceCPT

69990	Microsurgical technique (operating microscope) — reimbursed when billed with services in the 'Services Allowed with 69990' list following CMS guidelines
63707	Example primary procedure referenced in 'Services Allowed with 69990' mappings
61305	Add-on/associated procedure referenced in 'Services Allowed with 69990' mappings
63709	Resulting mapped procedure in 'Services Allowed with 69990' list

Bundling / Exclusion Notemixed

69990 + 64727

Per CMS/CCI, 69990 is not to be reported in addition to 64727

Examples of allowed primary procedures and mappingsCPTCovered

63707	Example primary procedure listed with allowed add-on mappings in Services Allowed with 69990
61305	Mapped with 63707 to 63709 per Services Allowed with 69990
63709	Mapped procedure result: 63707, 61305 = 63709
61312	Mapped with 63707 to 63710 per Services Allowed with 69990
63710	Mapped procedure result: 63707, 61312 = 63710
61313	Mapped with 63707 to 64831 per Services Allowed with 69990
64831	Mapped procedure result: 63707, 61313 = 64831
61314	Mapped with 63707 to 64832 per Services Allowed with 69990
64832	Mapped procedure result: 63707, 61314 = 64832
61315	Mapped with 63707 to 64834 per Services Allowed with 69990

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Bundling rule

Bundling rule for 64727CPT 64727 will be reimbursed only when submitted with internal neurolysis codes listed in the 'Services Allowed with CPT 64727' list.

CMS exclusion between 64727 and 69990Per CMS/CCI guidance, CPT 69990 is not to be reported in addition to CPT 64727.

69990 reimbursement alignmentUnitedHealthcare follows CMS reimbursement guidelines and will reimburse CPT 69990 only when billed with services on the 'Services Allowed with CPT 69990' list (specified nervous system surgeries).

Provider Responsibilities and Submission Guidance

Documentation Required

Provider responsibilities and claim submission

You are responsible for submission of accurate claims; coding must follow CPT/CMS guidance and UnitedHealthcare Community Plan may apply reasonable discretion in interpreting and applying this policy.

Submit accurate claims on CMS 1500 (and UB-04 when specified).
Follow CPT, CMS, and UnitedHealthcare coding and reimbursement guidance when reporting services.
UnitedHealthcare may use reasonable discretion in interpreting and applying this policy.

Billing Rule

Reimbursement contingent on allowed primary procedures

Reimbursement for codes 64727 and 69990 is allowed only when billed with primary procedures listed in the respective "Services Allowed" lists: 64727 only with internal neurolysis codes on the Services Allowed with CPT 64727 list; 69990 only with services in the Services Allowed with CPT 69990 list following CMS guidance.

CPT 64727 will be reimbursed only when submitted with internal neurolysis codes on the "Services Allowed with CPT 64727" list.
CPT 69990 will be reimbursed only when billed in conjunction with services described in the "Services Allowed with CPT 69990" list; UnitedHealthcare follows CMS reimbursement guidelines for 69990.
Per CMS/CCI, 69990 is not to be reported in addition to 64727.

Key Definitions

Microsurgical Technique

DefinitionMicrosurgical Technique — A surgical technique for dissecting tissues with a microscope; use of an operating microscope during a surgical procedure.

ScopeRefers to the use of an operating microscope reported with CPT codes 64727 and 69990 when applicable.

Policy noteUse of an operating microscope reported with CPT 64727 or 69990 is reimbursable only in specified instances per this policy.

Same Individual Physician or Other Qualified Health Care Professional

DefinitionSame Individual Physician or Other Qualified Health Care Professional — The same individual rendering health care services reporting the same Federal Tax Identification number.

ApplicationUsed to determine when services are attributable to the same provider for billing and reimbursement purposes.

Policy contextReferenced in determining reimbursement for operating microscope services reported with CPT codes 64727 and 69990.