This version of the policy will become effective on 01/14/2019.
The following main changes have been made to the policy:
Meniscal allograft transplantation (MAT) 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):
When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Policy: 11.14.09g:Osteochondral Autograft Transplantation (OAT) Procedure
Policy: 11.14.12e:Osteochondral Allograft Transplantation