Does C1776 require prior authorization?

No, C1776 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C1776`, Joint device (implantable)

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation of failure of conservative therapies (analgesics, viscosupplementation, arthroscopic debridement).
Clinical and/or imaging documentation demonstrating disease confined to a single compartment when proposing unicompartmental procedures.
Documentation confirming presence and localization of focal cartilage defect when considering autologous chondrocyte implantation or osteochondral transplant.
Use the written Medical Policy coverage position (not code lists) to determine coverage.

Initial treatment of uni- and bi-compartmental knee osteoarthritis with conservative measures such as analgesics, viscosupplementation, and arthroscopic debridement.
Autologous chondrocyte implantation or osteochondral transplant for focal cartilage defects of the knee.
Surgical interventions (e.g., osteotomy or unicompartmental arthroplasty) when conservative therapies have failed.
Isolated medial compartment knee osteoarthritis considered as an alternative to total knee replacement
Candidates typically are older adults (commonly >60 years) with a low level of physical activity and weight <180 pounds
High tibial osteotomy is the preferred option for younger patients with unicompartmental knee disease.

BCBSIL-SUR705.024, Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee

BCBSMT-SUR705.024, Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee

BCBSNM-SUR705.024, Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee

BCBSOK-SUR705.024, Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee

Ask Verity about documentation requirements, denial risks, or coverage in your state.