Robotic surgery HCPCS S2900 reimbursement
Defines UnitedHealthcare's reimbursement stance on HCPCS code S2900 (robotic surgical techniques) for UnitedHealthcare Commercial and Individual Exchange plans; affects providers submitting CMS-1500 claims.
No material clinical or coverage changes in this revision.
Reimbursement and Coverage Criteria
Reimbursement criteria
Covered when ALL of the following rules are met:
ALL of the following
- S2900 is considered integral to the primary surgical procedure and is not separately reimbursable; reimbursement is included in the primary procedure fee.
- When a surgical procedure is performed using code S2900, reimbursement is considered included as part of the primary surgical procedure.
- Modifier 22 should not be appended to the primary procedure solely to report use of robotic assistance.
- Modifier 22 may be used only when documentation supports substantial additional work unrelated to robotic assistance (e.g., increased intensity, time, technical difficulty, severity of patient’s condition, physical and mental effort).
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