CMM-312 Knee Surgery Arthroscopic and Open Procedures

CMM-312 covers knee arthroscopic and open procedures (diagnostic arthroscopy, lavage/chondroplasty, meniscectomy/repair, meniscal allograft, cartilage restoration including ACI/OATS/microfracture, ligament reconstructions, patellar realignment and high tibial osteotomy) only when strict, procedure‑specific clinical and imaging criteria are met and excludes interventions for advanced osteoarthritis or any cases not meeting those criteria (including inappropriate lesion size, age/BMI limits, or other non‑listed indications). Key requirements are documented severe, disabling pain with loss of function, objective physical‑exam findings and correlating MRI/arthroscopy, failure of conservative care (generally ≥3 months unless acute), and adherence to procedure‑specific limits (e.g., ACI defect 1–10 cm², age 15–55 and BMI ≤35; OATS autograft ≤2.5 cm² or allograft ≤10 cm², OATS age ≤49 and BMI <35; microfracture ≤2.5 cm²), plus documentation of prior treatments and ability to complete post‑op rehabilitation.