Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
Robotic surgical systems are developed to assist surgeons with performing minimally-invasive procedures. Designed to increase surgical precision and minimize complications, these systems may afford better outcomes for patients than traditional laparoscopic surgery or open surgery.
Conditions of Coverage
- RAS must be recommended by the attending surgeon;
- The underlying procedure is a covered procedure;
- No additional payment will be made for use of RAS beyond that for the underlying procedure; and
- The provider is required to clearly identify when RAS is used in order to track utilization and outcome.
Background Policy Information
The State Health Technology Clinical Committee (HTCC) reviewed RAS on May 18, 2012. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that no additional payment will be made for use of RAS beyond that for the underlying procedure currently indicated. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority.
Implementation of the Determination
All requests for RAS require prior authorization.