Medicare AdvantageAdministrativeLow impact
MA11.088c, Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
Independence Blue Cross·NJ · Orthopedics, General Surgery, Sports Medicine·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued Medical Policy MA11.088c on 03/04/2026 with no substantive changes to coverage criteria. Computer-assisted musculoskeletal surgical navigational orthopedic procedures remain non-covered (experimental/investigational) for New Jersey Medicare Advantage members. Billing teams should continue denying claims for CPT codes 0054T, 0055T, 20985, and 27599 when used for these procedures.
Action Required
No immediate action required. This is a reissue with no changes to existing policy. Billing team should verify that claims for CPT 0054T (fluoroscopic image-guided), CPT 0055T (CT/MRI image-guided), CPT 20985 (imageless), and CPT 27599 (femur/knee procedures using kinetic balance sensor) continue to be denied as experimental/investigational for all diagnoses under Independence Blue Cross Medicare Advantage plans in New Jersey. No workflow modifications are needed unless claims are currently being incorrectly approved.