Allograft Transplantation of the Knee - Medicare Advantage

This policy covers allograft transplantation of the knee — including meniscal allograft transplantation and use of allograft tissue for ligament reconstruction — for patients with absent or near-absent medial or lateral meniscus, minimal articular damage (Outerbridge grade II or less), a stable (or surgically corrected) knee, BMI ≤40 and age ≤50. Coverage requires documentation (eg, MRI or arthroscopy) and typically failure of conservative therapy unless acute trauma or active infection, is subject to the applicable MAC LCD/CMS guidance (eg, CMS NCD 150.12 for collagen meniscal implants), and excludes meniscal prostheses, tissue‑engineered menisci, and xenografts as not medically necessary.

"Documentation confirming normal knee alignment"

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