Wiki Any insurance pay for robotic surgery? 20985

Orthocoderpgu

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We have a new provider who does joint replacements and uses robots to help with surgery. Does any insurance pay for code 20985 separately or do they bundle this? Any advice from what you have seen would be helpful. Thanks.
 
I'm not sure if they pay separately but the code is billable since its an add-on code. CMS does have a fee attached to the code.
 
Jeanne CPC

Many Insurance do not pay for the navigation however we receive payment from the following insurance companies for CPT code 20985,
Anthem
Anthem BCBS of CA
Anthem BCBS of CT
Anthem BCBS of GA
BCBS of Blue Choice of New England
Blue Benefit of MA
Cigna
Coventry Health
Medicare
UHC State(RI)
UHC
UHC Rhody/ RiteCare (Medicaid)
Workers Compensation (RI)
It depends on the medical policy of the insurance and their fee schedule will determine the allowable. Good Luck!
 
We have a new provider who does joint replacements and uses robots to help with surgery. Does any insurance pay for code 20985 separately or do they bundle this? Any advice from what you have seen would be helpful. Thanks.

I'm a little late to the dance here....lol.....but code 20985 is for computer assisted coding, not robotic assistance. Per the AMA and a Knowledge Base Inquiry I did several years ago, even though you use a computer to control the robot, they see this as robotic assistance and not computer assistance. At that time they had no intention of creating a claim for robotic assistance.

Feel free to email me if you have further questions. I worked as a consultant and one of my clients had robotic assistance.
 
Robotic is S2900

I agree with that for robotic assistance the correct code is S2900. And that carriers generally don't pay for it. We were able to get 1 carrier to put it into our contract to pay for that code.
 
Email?

I'm a little late to the dance here....lol.....but code 20985 is for computer assisted coding, not robotic assistance. Per the AMA and a Knowledge Base Inquiry I did several years ago, even though you use a computer to control the robot, they see this as robotic assistance and not computer assistance. At that time they had no intention of creating a claim for robotic assistance.

Feel free to email me if you have further questions. I worked as a consultant and one of my clients had robotic assistance.

Hi,

I would love to talk with you about this subject, can you email me at pamela.guada@yahoo.com

Thank you,
Pamela
 
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