Osteochondral and Subchondral Defects Surgery - Medicare Advantage

This policy covers surgical and implant-based treatments for osteochondral and subchondral knee defects — including OATS, cryopreserved and juvenile osteochondral allografts, decellularized allografts, minced-cartilage/biopaste products, synthetic resorbable scaffolds, autologous chondrocyte implantation, and subchondroplasty — for patients with focal, full-thickness (Outerbridge grade 3–4) chondral/osteochondral defects of the knee. Coverage requires documentation (eg, MRI or arthroscopy) of an isolated defect typically ≥2–10 cm2, failure of ≥3 months of conservative treatment, absence of contraindications, and expected compliance with postoperative rehabilitation; certain codes/procedures (eg, S2112 arthroscopic cartilage harvest) are noted as not covered in the excerpt.

"Surgical treatment of osteochondral and subchondral defects of the shoulder — CPT 23929 (Unlisted procedure, shoulder)."