Notification

Meniscal Allograft Transplantation


Notification Issue Date: 10/16/2018

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):

  • autologous chondrocyte implantation, or
  • osteochondral allografting, or
  • osteochondral autografting.


Medical Policy Bulletin


Title:Meniscal Allograft Transplantation

Policy #:11.14.03f

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

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

Coverage is subject to the terms, conditions, and limitations of the member's contract.


Refer to the following News Article:
Meniscal allograft transplantation performed in combination with treatment of focal articular cartilage lesions

MEDICALLY NECESSARY

Meniscal allograft transplantation is considered medically necessary and, therefore, covered when all of the following criteria are met:
  • Adolescent individuals have reached skeletal maturity (e.g., 15 years of age or older) with documented closure of growth plates. Adult individuals should be too young to be considered an appropriate candidate for total knee arthroplasty or other reconstructive knee surgery (e.g., 55 years of age or younger).
  • The individual has a history of total or near-total meniscectomy.
  • The individual has disabling knee pain that is refractory to conservative treatment (e.g., physical therapy) and a stable knee joint without malalignment (or corrective surgery is planned prior to or in combination with the transplantation).
  • There are minimal-to-absent degenerative changes in the surrounding articular cartilage (e.g., Outerbridge grade II or less).

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):
  • autologous chondrocyte implantation, or
  • osteochondral allografting, or
  • osteochondral autografting.

EXPERIMENTAL/INVESTIGATIONAL

All other uses of meniscal allograft transplantation are considered experimental/investigational and, therefore, not covered because their safety and/or effectiveness cannot be established by review of the available published literature.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

Scientific evidence has demonstrated that MAT is a useful procedure in treating individuals younger than 55 years of age who have a history of total or near-total meniscectomy, disabling knee pain refractory to conservative treatment, a stable knee joint without malalignment (or planned corrective surgery prior to or in combination with the transplantation), and minimal-to-absent degenerative changes in the knee. In some circumstances, individuals older than 55 years of age may be considered viable candidates for the procedure.

OUTERBRIDGE GRADING SYSTEM
  • Grade I: Softening and swelling of cartilage
  • Grade II: Fragmentation and fissuring, less than 0.5 in. diameter
  • Grade III: Fragmentation and fissuring, greater than 0.5 in. diameter
  • Grade IV: Erosion of cartilage down to exposed subchondral bone

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, meniscal allograft transplantation is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

Description

The meniscus is a wedge-shaped structure composed of collagen bundles and located between the tibia and the femur on the medial and lateral aspects of the knee. Because of its great tensile strength and stiffness, the meniscus is responsible for distributing body weight over a broad area of articular cartilage surface, absorbing shock during loading, and improving joint stability and lubrication.

Repair of an intact meniscus is always preferable to surgical removal (meniscectomy), but in instances when the meniscus cannot be saved, meniscectomy may be necessary. Because the meniscus is critical to preserving articular cartilage and retarding degenerative arthritis, meniscal transplantation has become a treatment option for select individuals who have undergone total or near-total meniscectomy.

The literature is lacking in large, well-designed, long-term, comparative studies on meniscal allograft transplantation (MAT). Among the few available studies, there are many unmatched variables. The optimum graft processing technique has not been agreed upon, and the method of clinical evaluation varies among studies. However, in small studies, good-to-excellent results in graft healing and revascularization with viable host cells have been reported in select patient populations. Clinical improvement in pain relief and reduction of arthrosis associated with MAT has also been described.

Preservation of meniscal tissue is important for long-term joint function, especially in younger individuals who are athletically active. 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. When there are no other treatment options, particularly in an active population younger than 55 years of age, MAT has been shown to be effective in the treatment of individuals with a history of total or near-total meniscectomy, disabling knee pain refractory to conservative treatment, a stable knee joint without malalignment (or planned corrective surgery prior to or in combination with the transplantation), and minimal-to-absent degenerative changes in the knee. Evidence shows that MAT can alleviate debilitating symptoms and possibly prevent or delay the onset of degenerative conditions in carefully selected, young, active individuals for whom other alternatives are not available. Although some studies report good outcomes with MAT in individuals older than 55 years of age, the preponderance of studies support the surgery for individuals younger than 55 years of age.

The American Academy of Orthopaedic Surgeons (AAOS) recommends the following criteria for individuals considering MAT:
  • Younger than 55 years and physically active
  • Missing more than half of a meniscus as a result of previous surgery or injury, or a meniscus tear that cannot be repaired
  • Persistent activity-related pain
  • Knee with stable ligaments and normal alignment
  • No or minimal knee arthritis
  • Not obese

Contraindications to the procedure include severe degenerative changes in the knee joint, uncorrected joint instability, malalignment, and a history of infection in the joint. Individuals with total meniscectomies who are asymptomatic are not considered candidates for MAT.

There is no standardized rehabilitation protocol after transplantation, but most clinicians recommend early range-of-motion exercises followed by non-weight bearing or toe-touch weight bearing with a hinged knee brace for four to six weeks. Unprotected full-weight bearing is allowed at four to nine months.

PEER-REVIEWED LITERATURE

In a retrospective case series, van der Wal et al. (2009) evaluated the long-term clinical outcomes of 57 individuals who had a total of 63 open meniscal allografts. The mean age at time of transplantation was 39.4 6.9 years, and the clinical outcome and failure rates were evaluated at 13.8 2.8 years. The overall failure rate was 29% (n=18). Overall, Lysholm scores significantly improved from 36 18 preoperatively to 61 20 at long-term follow-up (higher scores indicating increased ability to engage in activities of daily living). The authors concluded that long-term follow-up results indicated that MAT was a beneficial procedure and could provide improvements in clinical function and pain relief in the short-term. The authors indicated that MAT is a good salvage option in symptomatic post-meniscentomized knees. MAT can also be used to postpone total knee arthroplasty in younger individuals. The authors called for additional long-term studies to evaluate optimal timing and technique for MAT in addition to comparative studies with arthroscopic-assisted MAT. The study is limited in its small sample size and the lack of a control group for comparative analysis.

In a retrospective case study, Gonzalez-Lucena et al. (2010) evaluated the functional and radiographic results of MAT performed with suture fixation without any bone block on 33 individuals with a mean age of 38.8 years [21 to 54]. The functional outcomes were evaluated by use of Lysholm and Tegner scores at a mean follow-up of 6.5 years and 5 years, respectively. Higher Lysholm and Tegner scores are associated with increased knee function and activity levels, respectively. A Visual Analogue Scale (VAS) pain score was also utilized. Radiographic assessment included magnetic resonance imaging (MRI) evaluation. Lyshom and Tegner functional scores improved from 65.4 to 88.6 (p < 0.001) and from 3.1 to 5.5 (p < 0.001), respectively. Average VAS pain scores significantly dropped from 6.4 to 1.5 (p < 0.001). Radiographic evaluation did not reveal any joint space narrowing (p = 0.38). The survival rate was 87.8% at 6.5 years and the rate of complications was 33%. The authors concluded that MAT provides significant pain relief and functional improvement in selected symptomatic individuals on a midterm basis. However, they noted that there was a high rate of complications and revision surgery.

In a systematic review, Harris et al. (2011) evaluated outcomes after combined MAT and cartilage restoration or repair. The authors included six case series in their analysis with a total of 110 individuals who underwent combined MAT and cartilage repair or restoration. Patients underwent MAT and either autologous chondrocyte implantation (n=73), osteochondral allograft (n=20), osteochondral autograft (n=17), or micrograft (n=3). In four of the six case series, overall outcomes of combined surgery were equivalent to those of either procedure performed in isolation. The remaining case series indicated that the overall outcomes of combined surgery were worse than procedures performed in isolation. Failure occurred in 12% of individuals who underwent MAT and cartilage restoration or repair, and they required revision surgery. The authors concluded that despite low rates of complications, there is a high rate of subsequent surgery after combined MAT and cartilage restoration or repair.

In a meta-analysis, ElAttar et al. (2011) evaluated the safety and effectiveness of MAT. The authors analyzed 44 trials representing 1,136 grafts in 1,068 individuals with a mean age of 34.8 years of age [14 to 69]. Most study participants had undergone several previous surgical procedures (up to 30) on their involved knees, with an average of 2.5 procedures. MAT was primarily performed to relieve compartmental symptoms, including joint line pain, swelling, and crepitations, following sub or total meniscectomy. Contraindications to MAT include asymptomatic individuals, diffuse joint pain and/or degeneration, arthrofibrosis, muscular atrophy, history of knee sepsis, and some general diseases and conditions such as immune disorders, diabetes mellitus, rheumatoid arthritis, gout, and marked obesity. Most of the trials presented short- or medium-term results of MAT. The follow-up period ranged between 8 months and 20 years, with an overall average of 4.6 years. Good healing and incorporation of the graft were frequently documented. Twelve different scoring systems were described in the MAT literature. The average overall preoperative Lysholm score increased from 44 to 77 at latest follow-up. Similarly, the overall Tegner activity score increased from a mean of 3 to 5. The overall VAS pain score decreased from 48 to 17 mm. However, the improvement in these scores showed a tendency to slowly decrease over time. At the time of latest follow-up, 84% of individuals were classified as normal or near-normal according to their International Knee Documentation Committee (IKDC) scores and 89% of individuals were satisfied with their outcome. The authors concluded that MAT is a safe, reliable procedure and should no longer be considered experimental. Although patient age in the reviewed trials ranged between 14 and 69 years, MAT is usually limited to skeletally mature individuals under 50 to 55 years of age. The authors noted that the ideal MAT candidate would have failed conservative treatment with symptoms that appeared some time after near or total meniscectomy and is too young to consider arthroplasty. The knee should be stable and the limb should be well-aligned so the graft's survival is not jeopardized.

In a review, Shybut and Strauss (2011) evaluated the surgical management of meniscal tears. The authors noted that MAT has been developed to address individuals with symptomatic total meniscal deficiency. Initially, there was hope that MAT may halt osteoarthritis progression in individuals with osteoarthritis. However, the results in these individuals were particularly poor. Patients with significant chondromalacia are considered poor candidates, and contraindications to MAT include condylar flattening or osteophyte formation. The knee must be stable, so any ligamentous deficiencies (e.g., anterior cruciate ligament or posterior cruciate ligament) must be addressed concurrently. Along those lines, any malalignment must also be addressed. The patient should be relatively young, typically under 50 years of age. Finally, and most critically, the patient must have pain in the compartment. This compartment-specific pain in meniscal deficiency has been called the “post-meniscectomy syndrome.” The ideal patient, therefore, is young, without any ligamentous instability, has a normally aligned knee with intact cartilage surfaces, and has focal pain in the meniscus deficient compartment. The authors concluded that MAT is a salvage operation with narrow indications.

In a literature review, Noyes et al. (2012) provided a comprehensive update of the available peer-reviewed literature. The authors noted that the preservation of meniscal tissue and function is important for long-term joint function, especially in younger individuals who are athletically active. In appropriate individuals, MAT offers the potential to restore partial load-bearing meniscus function, decrease symptoms, and provide chondroprotective effects. MAT is no longer considered experimental, as over 30 clinical studies involving hundreds of individuals have been published. The authors indicate that contraindications to the procedure may include individuals who are older than 60 years of age or are unwilling to follow postoperative rehabilitation programs.

In a review, Lee et al. (2012) provided a summary of MAT. The authors noted that surgery should be considered for symptomatic meniscus-deficient knees only after all nonsurgical treatments have been utilized. Successful meniscal transplantation depends on proper patient selection and screening. Patients are typically young (e.g., 50 years of age and younger) and often present with a history of total or subtotal meniscectomy with persistent pain. The knee joint must be stable and have normal alignment, with intact articular surfaces (Outerbridge Grade I or II). Contraindications for MAT include diffuse arthritic changes, squaring or flattening of the femoral condyle or tibial plateau, significant osteophyte formation in the involved compartment, Outerbridge grade IV articular changes, untreated tibiofemoral subluxation, inflammatory arthritis, synovial disease, previous joint infection, skeletal immaturity, or marked obesity. The authors concluded that MAT yields fair to excellent results in almost 85% of individuals. Patients demonstrate a significant decrease in pain, as well as an increase in activity. The authors noted that long-term success was encouraging in well-selected individuals, but it is unknown whether MAT is protective against degenerative progression of disease.

In a retrospective case study, Zhang et al. (2012) reported on the initial results of MAT after a 2-year follow-up period with second-look arthroscopy in 18 individuals. Seven medial and 11 lateral meniscus allografts were evaluated with a mean follow-up of 24.9 months [18 to 41]. The clinical outcome and failure rate were evaluated by use of second-look arthroscopy in all individuals, MRI analysis in 17 individuals, and standardized outcome scores assessment. Overall, 67% of the study participants (n=12) reported that they were completely or mostly satisfied with the procedure. Patients demonstrated statistically significant improvements in standardized outcome scores and overall pain VAS scores. The authors concluded that MAT can achieve satisfying subjective and objective clinical outcomes, with a failure of 11% after 1 to 3 years of follow-up, as documented by second-look arthroscopy. The study is limited in its small sample and short follow-up period.

In a retrospective case study, McCormick et al. (2014) evaluated the mean survival rate of allografts and reoperation rates in 200 individuals who underwent MAT. Ultimately, 86% of study participants (n=172) were evaluated for a mean of 59 months [24 to 118 months], with a minimum of 2-year follow-up. Secondary outcome measurements included reoperation rates and meniscal and articular cartilage status. Survival was defined as a lack of revision MAT or knee arthroplasty. Forty-one percent of the MATs were performed alone, while 59% were performed concomitantly. Thirty-two percent of individuals (n=64) returned for reoperation after their index procedure, with arthroscopic debridement being performed in 59% of these individuals (n=38). The mean time to subsequent surgery was 21 months [2 to 107 months], with 73% of revision surgeries occurring within 2 years. Individuals requiring revision surgery within 2 years had 8.4 times the odds of having a future arthroplasty or MAT revision compared to individuals who required secondary surgery after 2 years. Allograft survival rates were 95% at a mean of 5 years. The authors concluded that there was a 32% reoperation rate for MAT in this study population, with simple arthroscopic debridement being the most common surgical treatment. The study is limited in its retrospective study design and lack of a comparative control group.

SUMMARY

MAT appears to improve symptoms in select individuals with a prior meniscectomy who are considered too young to undergo total knee replacement. Short- to intermediate-term results are promising. However, the current available peer-reviewed literature does not permit conclusions concerning the effect of MAT on the long-term progression of degenerative changes and joint space narrowing.

MAT is associated with a reoperation rate of up to 32% and a high number of complications, including tears of the transplanted meniscus, displacement, or arthrofibrosis. Therefore, careful patient selection appears to be critical for successful surgical outcomes. MAT is considered a salvage procedure and is not recommended to be performed by surgeons without extensive experience and expertise in complex knee reconstruction. Based on the available evidence, clinical input, and recommendations from relevant medical societies, MAT may be considered medically necessary in individuals younger than 55 years of age with disabling knee pain who have not shown an adequate response to physical therapy and analgesic medications.

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.
References


Alleyne KR, Galloway MT. Management of osteochondral injuries of the knee. Clin Sports Med. 2001;20(2):343-364.

Amendola A. Knee osteotomy and meniscal transplantation: indications, technical consideration, and results. Sports Med Arthrosc. 2007;15(1):32-38.

American Academy of Orthopaedic Surgeons (AAOS). The diagnosis and treatment of osteochondritis dissecans: guideline and evidence report. [AAOS Web site]. 2010. http://www.aaos.org/research/guidelines/OCD_guideline.pdf. Accessed October 10th, 2016.

American Academy of Orthopaedic Surgeons (AAOS). Meniscal transplant surgery. [AAOS Web site]. February 2009. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00381. Accessed October 10th, 2016.

Buckwalter JA, Mow VC. Basic science and injury of articular cartilage, menisci, and bone. In: DeLee JC, Drez D, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine: Principles and Practice. 2nd ed. Philadelphia, PA: Saunders; 2003:96. Also available online at: http://home.mdconsult.com/das/book/31001140/view/1103?sid=204417651 [via subscription only]. Accessed October 10th, 2016.

Chambers HG, Shea KG, Anderson AF, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis and treatment of osteochondritis dissecans. J Bone Joint Surg Am. 2012;94(14):1322-4.

Chang HC, Teh KL, Leong KL, et al. Clinical evaluation of arthroscopic-assisted allograft meniscal transplantation. Ann Acad Med Singapore. 2008;37(4):266-272 (Abstr).

Cole BJ, Dennis MG, Lee SJ, et al. Prospective evaluation of allograft meniscus transplantation: A minimum 2-year follow-up. Am J Sports Med. 2006;34(6):919-927.

Dienst M, Kohn D. Allogenic meniscus transplantation. Oper Orthop Traumatol. 2006;18(5-6):463-480.

ElAttar M, Dhollander A, Verdonk R, et al. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):147-57.

Erikkson E. Meniscus tranplantation. Knee Surg Sports Traumatol Arthrosc.
2006;14(8):693.

Farr J, Rawal A, Marberry KM. Concomitant meniscal allograft transplantation and autologous chondrocyte implantation: minimum 2-year followup. Am J Sports Med. 2007;5(9):1459-1466.

Felix NA, Paulos LE. Current status of meniscal transplantation. Knee. 2003;10(1):13-17.

Gitelis S, Cole BJ. The use of allografts in orthopaedic surgery. Instr Course Lect. 2002;51:507-520.

Gomoll AH, Kang RW, Chen AL, et al. Triad of cartilage restoration for unicompartmental arthritis treatment in young patient: meniscus allograft transplantation, cartilage repair and osteotomy. J Knee Surg. 2009;22(2):137-141.

Gonzalez-Lucena G, Gelber PE, Pelfort X, et al. Meniscal allograft transplantation without bone blocks: a 5- to 8-year follow-up of 33 patients. Arthrosc Related Surg. 2010;26(12):1633-40.

Harris, JD, Cavo, M, Brophy, R, et al. Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy. 2011;27(3):409-18.

Harston A, Nyland J, Brand E et al. Collagen meniscus implantation: a systematic review including rehabilitation and return to sports activity. Knee Surg Sports Traumatol Arthrosc. 2012; 20(1):135-46.

Heckman TP, Barber-Westin SD, Moyes FR. Meniscal repair and transplantation: indications, techniques, rehabilitation, and clinical outcome. J Orthop Sports Phys Ther. 2006;36(10).

Hommen JP, Applegate GR, Del Pizzo W. Meniscus allograft transplantation: ten-year results of cryopreserved allografts. Arthroscopy. 2007;23(4):388-393.

Johnson DL, Bealle D. Meniscal allowgraft transplantion. Clin Sports Med.1999;18(1):93-108.

Lee AS, Kang RW, Kroin E, et al. Allograft meniscus transplantation. Sports Med Arthrosc Rev. 2012;20(2):106-114.

Lubowitz JH, Verdonkl PC, Reid JB 3rd, et al. Meniscus allograft transplantation: a current concepts review. Knee Surg Spor Traumatol Arthrosc. 2007;15(5):476-492.

Matava MJ. Meniscal allograft transplantation: a systematic review. Clin Orthop Relat Res. 2007;455:142-157.

McCormick F, Harris JD, Abrams GD, et al. Survival and reoperation rates after meniscal allograft transplantation: analysis of failures for 172 consecutive transplants at a minimum 2-year follow-up. Am J Sports Med. 2014;42(4):892-7.

Noyes FR, Barber-Westin SD, Rankin M. Meniscal transplantion in sylmptomatic patients less than fifty years old. J Bone Joint Surg Am. 2004;86-A(7):139201404.

Noyes FR, Barber-Westin SD, Rankin M. Meniscal transplantation in symptomatic patients less than fifty years old. J Bone Joint Surg Am. 2005;87(Suppl 1)(Pt 2):149-165.

Noyes FR, Heckmann TP, Barber-Westin SD. Meniscus repair and transplantation: a comprehensive update. J Orthop Sports Phys Ther. 2012;42(3):274-90.

Peters G, Wirth CJ. The current state of meniscal allograft transplantation and replacement. Knee. 2003;10(1):19-31.

Rath E, Richmond JC, Yassir W, et al. Meniscal allograft transplantation. Two- to eight-year results. Am J Sports Med. 2001;29(4):410-414.

Rodeo SA. Meniscal allografts - where do we stand? Am J Sports Med. 2001;29(2):246-261.

Rue JP, Yanke AB, Busam ML, et al. Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair: minimum 2 year follow-up. Am J Sports Med. 2008;36(9):1770-1778.

Rueff D, Nyland J, Kocabey Y, et al. Self-reported patient outcomes at a minimum of 5 years after allograft anterior cruciate ligament reconstruction with or without medial meniscus transplantation: An age, sex and activity level-matched comparison in patients aged approximately 50 years. Arthroscopy. 2006;22(10):1053-1062.

Sekiya JK, Ellingson CI. Meniscal allograft transplantation. J Am Acad Orthop Surg. 2006;14(3):164-174.

Sekiya JK, Giffin JR, Irrang JJ, et al. Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction. Am J Sports Med.
2003;31(6):8960906.

Sekiya JK, West RV, Groff YJ, et al. Clinical outcomes following isolated lateral meniscal allograft transplantation. Arthroscopy. 2006;22(7):771-780.

Shybut, T, Strauss EJ. Surgical management of meniscal tears. Bull NYU Hosp Jt Dis.
2011;69(1):56-62.

Sohn DH, Toth AP. Meniscus transplantation: current concepts. J Knee Surg. 2008;21(2):163-172.

Tom JA, Rodeo SA. Soft tissue allografts for knee reconstruction in sports medicine. Clin Orthop Relat Res. 2002;402:135-156.

van der Wal RJ, Thomassen BJ, van Arkel ER. Long-term clinical outcome of open meniscal allograft transplantation. Am J Sports Med. 2009 June 19 [Epub ahead of print].

Verdonk PC, Demurie A, Almqvist KF, et al. Transplantation of viable meniscal allograft. Surgical technique. Survivorship analysis and clinical oucome of one hundred cases. J Bone Joint Surg Am. 2005;87(4):715-724.

Verdonk PC, Demurie A, Almqvist KF, et al. Transplantation of viable meniscal allograft. Surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1)(Pt 1):109-118.

Verdonk PC, Verstraete KL, Almqvist KF, et al. Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):694-706.

von Lewinski G, Milachowski KA, Weismeier K, et al. Twenty-year results of combined meniscal allograft transplantation, anterior cruciate ligament reconstruction and advancement of the medial collateral ligament. Knee Surg Sports Traumatol Arthrosc.
2007;15(9):1072-1082.

Wirth CJ, Peters G, Milachowski KA, et al. Long-term results of meniscal allograft transplantation. Am J Sports Med. 2002;30(2):174-181.

Yoldas EA, Sekiya JK, Irrgang JJ, et al. Arthroscopically assisted meniscal allograft transplantion with and without combined anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2003;11(3):173-182.





Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

29868


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

See Attachment A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References

Attachment A: Meniscal Allograft Transplantation
Description: ICD-10-CM codes




Policy History

Revisions from 11.14.03f:
01/14/2019This 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):
  • autologous chondrocyte implantation, or
  • osteochondral allografting, or
  • osteochondral autografting.


Effective 10/05/2017 this policy has been updated to the new policy template format.



Version Effective Date: 01/14/2019
Version Issued Date: 01/14/2019
Version Reissued Date: N/A

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