MA11.081b Meniscal Allograft Transplantation
MA00.047b Musculoskeletal Services
The purpose of this communication is to provide notice regarding coverage position of meniscal allograft transplantation performed in combination with treatment of focal articular cartilage lesions.
Meniscal allografts and other meniscal implants (e.g., collagen) are intended to improve symptoms and reduce joint degeneration in individuals who have had a total or partial meniscus resection. Meniscal allograft transplantation (MAT) is considered a salvage procedure, reserved for individuals with disabling knee pain following meniscectomy who are considered too young to undergo total knee arthroplasty (TKA) or in individuals who require a total or near total meniscectomy for irreparable tears. As a result, the population intended to receive these transplants is relatively limited. Although MAT can be performed by itself to meet clinical needs, meniscal allograft transplantation may be clinically indicated when performed in combination, either concurrently or sequentially, with treatment of focal articular cartilage lesions using procedures of autologous chondrocyte implantation, osteochondral allografting, or osteochondral autografting; when the latter treatments are also medically necessary.
Meniscal allograft transplantation is considered medically necessary and, therefore, covered when criteria in Company's medical policy entitled Meniscal Allograft Transplantation (Policy #: MA11.081) are met. Furthermore, meniscal allograft transplantation is considered medically necessary and, therefore, covered when performed in combination, either concurrently or sequentially, with treatment of focal articular cartilage lesions using any of the procedures listed below; when clinical criteria for medical necessity are met for each of the individual procedures (i.e. meniscal allograft transplantation AND one of these three procedures):