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Computer-Assisted Surgical Navigation for …

Computer-Assisted Surgical N a viga tion for Musculoskeleta l Pr ocedur es Page 1 of 8 UnitedHea lthca r e Commer cia l Medica l Policy Effective 10/01/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. UnitedHealthcare Commercial Med i ca l P ol i cy Computer-Assisted Surgical Navigation for Musculoskeletal Procedures Policy Number: 2021T0599D Effective Date: October 1, 2021 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Definitions .. 1 Applicable Codes .. 1 Description of Services .. 2 Clinical evidence .. 2 Food and Drug Administration .. 6 References .. 7 Policy History/Revision 8 Instructions for Use .. 8 Coverage Rationale Computer-Assisted Surgical Navigation for musculoskeletal procedures of the pelvis and appendicular skeleton is unproven and not medically necessary due to insufficient evidence of efficacy. The use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty is unproven and not medically necessary due to insufficient evidence of efficacy.

Clinical Evidence . Hip/Pelv is The evidence on the relative benefits of CAN with conventiona ol r minimally invasvie tota lhip arthroplasty is inconsistent; quality randomized controlled trials, and evidence for benefit of the technology on patient -centered outcome are lackni g. The evidence

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