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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 Vinci^TM 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.

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

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.

Covered Codes