S2900, Surgical techniques requiring use of robotic surgical system (list separately
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Use of intra-operative/intra-wound vancomycin powder: document dosing/administration, indication, baseline infection risk factors, and post-operative monitoring for wound complications, AKI, ototoxicity (authors reported no statistical difference but monitored these endpoints).
- When using TXA: documentation of procedure type (primary THA), route and dosing of TXA (intravenous, topical, or combined), and exclusion/consideration if revision THA or hip fracture surgery (VHA: evidence lacking in revisions/hip fracture).
- Robotic or navigation-assisted THA: pre-operative target angles, intra-operative navigation records (intra-operative cup angles using navigation records), and post-operative imaging to verify cup orientation (post-operative CT data or radiographs) as used in the cited studies (e.g., HipAlign intra-op records vs post-op CT comparisons).
Key Coverage Criteria
- Removable oral appliances are proven and medically necessary for treating obstructive sleep apnea (OSA) when a sleep study confirms diagnosis and prior evaluation has occurred.
- Progressive or substantial periprosthetic bone loss confirmed by imaging;
- Outside-in arthroscopic psoas release for anterior iliopsoas impingement after primary total hip arthroplasty
- Fracture or mechanical failure of 1 or more components of the prosthesis confirmed by imaging;
- Confirmed periprosthetic infection confirmed by gram stain and culture;
- Displaced periprosthetic fracture confirmed by imaging;
7 Active Policies
CGS-L40232, Total Joint Arthroplasty
J15
AETNA-CPB-0287, Hip Arthroplasty
AETNA-CPB-0660, Knee Arthroplasty
UHC-POL-obstructive-sleep-apnea-treatment, Obstructive and Central Sleep Apnea Treatment
A60250, Billing and Coding: Total Joint Arthroplasty
Related Codes
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