2025 CPT code 69990
(Active) Effective Date: N/A Revision Date: N/A Surgery - Operating Microscope Procedures Surgery Feed
Use of operating microscope during microsurgery; reported in addition to the primary procedure code.
Modifiers 52 (reduced services) and 53 (discontinued procedure) could be applicable depending on the circumstances of the primary procedure. Other modifiers should only be used if applicable to the primary procedure code.
Medical necessity is established by the documentation supporting the need for the primary surgical procedure and the use of microsurgical techniques for that procedure. The operating microscope is considered medically necessary when it's essential for visualization and precise manipulation required by microsurgery, particularly in cases involving small structures such as nerves, blood vessels, or delicate tissues.Payer-specific criteria for medical necessity may apply.
The surgeon uses microsurgical instruments and techniques under magnification provided by the operating microscope. The physician is responsible for performing the primary procedure and operating the microscope for optimal visualization during the microsurgery.
In simple words: This code is added to the bill if the doctor used a special microscope during surgery to help see very small areas better and perform precise cuts and stitches.It's only billed once per surgery, even if the microscope was used many times. It is not billed if the microscope is a standard part of the main surgery.
This code reports the use of an operating microscope during a surgical procedure that employs microsurgical techniques.It is an add-on code and should be reported separately in addition to the code for the primary procedure performed.The operating microscope provides magnified visualization of the surgical field, facilitating precise cutting and suturing with microsurgical instruments. This code is not reported for procedures where the microscope's use is an inherent component of the primary procedure, nor is it reported for visualization with magnifying loupes or corrected vision.Only one instance of 69990 should be reported per operative session, regardless of how many procedures utilized the microscope.
Example 1: A neurosurgeon performs a microvascular decompression for trigeminal neuralgia, using an operating microscope for precise visualization and manipulation of the cranial nerves and blood vessels. Code 69990 is reported in addition to the code for the microvascular decompression procedure., An ophthalmologist performs a complex retinal reattachment procedure, utilizing the operating microscope for precise visualization and manipulation of the delicate retinal tissues. Code 69990 is reported in addition to the code for the retinal reattachment., An otolaryngologist performs a stapedectomy using the operating microscope. This code is reported in addition to the CPT code for the stapedectomy.Note: the specific stapedectomy codes may have built-in operating microscope use; verify guidelines before reporting 69990.
Operative report clearly documenting the use of an operating microscope during the procedure, specifying the type of microsurgical techniques performed (e.g., microanastomosis, microdissection), and the specific primary procedure codes performed.Documentation must clearly distinguish between the use of an operating microscope vs. loupes or standard magnification.
** Pay close attention to payer-specific guidelines, as reimbursement policies for 69990 may vary. Some payers may have specific lists of allowed primary procedure codes to be used in conjunction with 69990.
- Revenue Code: Y1 (OTHER - MEDICARE FEE SCHEDULE)
- Payment Status: Active
- Modifier TC rule: Not applicable.This is an add-on code.
- Specialties:Neurosurgery, ophthalmology, otolaryngology, plastic surgery, microsurgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center