Print Robotically Assisted Laparoscopic Radical Prostatectomy

Robotically Assisted Laparoscopic Radical Prostatectomy



Robot-assisted surgery is the latest development in the larger movement of endoscopy, a type of minimally invasive surgery--the idea being that less invasive procedures translate into less trauma and pain for patients. Surgery through smaller incisions typically results in less scarring and faster recovery. It's not that robots are changing the basics of surgery. Surgeons are still cutting and sewing like they have been for decades. Robots represent a new computer-assisted tool that provides another way for surgeons to work.

Rather than cutting patients open, endoscopy allows surgeons to operate through small incisions by using an endoscope. This fiber optic instrument has a small video camera that gives doctors a magnified internal view of a surgical site on a television screen.

With robotic surgical systems, surgeons don't move endoscopic instruments directly with their hands. Instead, surgeons sit at a console several feet from the operating table and use joysticks similar to those used in video games. They perform surgical tasks by guiding the movement of the robotic arms in a process known as tele-manipulation.

Two robotic surgical systems have received FDA clearance to be marketed in the United States: The da Vinci Surgical System, made by Intuitive Surgical, Inc. of Sunnyvale, Calif., is cleared to perform surgery under the direction of a surgeon. The ZEUS Robotic Surgical System, made by Computer Motion, Inc. of Goleta, Calif., has been cleared by the FDA to assist surgeons.

The Intuitive Surgical® Endoscopic Instrument Control System (referred to as the "da VinciTM System") is intended to assist in the accurate control of Intuitive Surgical® endoscopic instruments including: rigid endoscopes, blunt and sharp endoscopic dissectors, scissors, scalpels, forceps/pick-ups, needle holders, endoscopic retractors, stabilizers, electrocautery and accessories during laparoscopic surgical procedures such as cholecystectomy, Nissen fundoplication, radical prostatectomy, and general non-cardiac thoracoscopic surgical procedures such as internal mammary artery mobilization. It is intended to be used by trained physicians in an operating room environment.

Intuitive Surgical® Endoscopic Instruments including scissors, scalpels, forceps/pick-ups, needle drivers and electrocautery are intended for endoscopic manipulation of tissue, including: grasping, cutting, blunt and sharp dissection, approximation, ligation, electrocautery and suturing.



Robotically Assisted Laparoscopic Radical Prostatectomy is considered medically necessary. (revised 7-21-2005)






Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.



3/2003: Approved by Medical Policy Advisory Committee (MPAC) as investigational

3/10/2004: Code Reference section completed, CPT code 55899 added

7/21/2005: Reviewed by MPAC, changed from investigational to medically necessary, Code Reference section non-covered codes table changed to covered codes table, HCPCS S2900 added, ICD-9 diagnosis code 185, 198.82, 233.4 added

10/26/05:  Code Reference section updated, CPT code 55866 added, CPT code 55866 and HCPCS S2900 description revised

3/24/2006: Coding notes removed from 55899, 55866 and S2900

3/28/2006: Policy reviewed, no changes

9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied




Michelle Meadows. Robots Lend a Helping Hand to Surgeons. U.S. Food and Drug Administration FDA Consumer Magazine: May-June 2002


Inderbir S. Gill, MD, MCh, and Gyung Tak Sung, MD. Clinic Pioneers Robotic Surgery Techniques – 2001: The Cleveland Clinic. Urology News.


Linda Bren. Robots Help Surgeons Perform More Precise Surgery. U.S. Food and Drug Administration FDA Consumer Magazine: November-December 2000.



This may not be a comprehensive list of procedure codes applicable to this policy.

The code(s) listed below ae ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.

Covered Codes

Code Number




Unlisted procedure, male genital system (added 3-10-2004) (changed to covered 7-21-2005)


Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing (added 10-26-2005)

ICD-9 Procedure


Laparoscopic robotic assisted procedure (new 10-1-2008)

ICD-9 Diagnosis


Malignant neoplasm of prostate (added 7-21-2005)

198.82Secondary malignant neoplasm of genital organs (added 7-21-2005)
233.4Carcinoma in situ of prostate (added 7-21-2005)



Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure) (added 7-21-2005)