CPT for ENT: Operating Microscope

Q: Can I bill for use of the operating microscope, Code 69990?

A: Yes. Otolaryngologists commonly use the operating microscope while performing a variety of microsurgical procedures. CPT +69990, Use of operating microscope (list separately in addition to code for primary procedure), is a billable CPT code. This code should be billed with surgical procedures that require use of a surgical microscope in order to perform techniques of microsurgery, when the use of a microscope is not an inclusive part of the major procedure. As an add-on code it will not require use of the 51 modifier.

AMA CPT 2017 states:

The surgical microscope is employed when the surgical services are performed using the techniques of microsurgery. Code +69990 should be reported (without modifier 51 appended) in addition to the code for the primary procedure performed. Do not use +69990 for visualization with magnifying loupes or corrected vision. Do not report +69990 in addition to procedures where use of the operating microscope is an inclusive component (15756-15758, 15842, 19364, 19368, 20955-20962, 20969-20973, 22551, 22552, 22856-22861, 26551- 26554, 26556, 31526, 31531, 31536, 31541, 31545, 31546, 31561, 31571, 43116, 43180, 43496, 46601, 46607, 49906, 61548, 63075-63078, 64727, 64820- 64823, 65091-68850, 0184T, 0308T, 0402T).

+69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)

The CPT language above states not to report +69990 where use of the operating microscope is an inclusive component of a service. However, some Otolaryngology services, such as many otologic procedures or sometimes a revision parotidectomy, utilize the microscope but are not listed in the exclusionary parenthetical.

Lastly, while reporting +69990 in these cases is appropriate by CPT convention, one should always check individual payer policy to determine the situations for which +69990 may be reported. At this time, generally Medicare does not reimburse +69990 with otologic procedures, nor do a number of private carriers. Most payers will allow reporting of +69990 with skull base procedures.  Always remember to document appropriately to support the use of se the code.

Revised October 2023
Published August 2006

IMPORTANT DISCLAIMER NOTICE

CPT FOR ENT ARTICLES ARE A COLLABORATIVE EFFORT BETWEEN THE ACADEMY’S TEAM OF CPT ADVISORS, MEMBERS OF THE PHYSICIAN PAYMENT POLICY (3P) WORKGROUP, AND HEALTH POLICY STAFF. ARTICLES ARE DEVELOPED TO ADDRESS COMMON CODING QUESTIONS RECEIVED BY THE HEALTH POLICY TEAM, AS WELL AS TO CLARIFY CODING CHANGES AND CORRECT CODING PRINCIPLES FOR FREQUENTLY REPORTED ENT PROCEDURES. THESE ARTICLES ARE NOT INTENDED AS LEGAL, MEDICAL, OR BUSINESS ADVICE AND ARE NOT A GUARANTEE OF REIMBURSEMENT. THE INFORMATION IS ALSO NOT MEANT TO SERVE AS THE DEFINITIVE OR SOLE AUTHORITY ON BILLING AND CODING ISSUES. THE APPLICABILITY OF AAO-HNS BILLING AND CODING GUIDANCE FOR A PARTICULAR PROCEDURE, MUST BE DETERMINED BY THE RESPONSIBLE PHYSICIAN IN LIGHT OF ALL THE CIRCUMSTANCES PRESENTED BY THE INDIVIDUAL PATIENT. YOU SHOULD CONSULT WITH YOUR OWN ADVISORS AS WELL AS MEDICARE OR PRIVATE CARRIERS IN MAKING ANY DECISIONS ABOUT HOW TO BILL AND CODE PARTICULAR SERVICES OR PROCEDURES.