Meniscal Allografts and Other Meniscal Implants

This policy covers meniscal allograft transplantation and other meniscal implants to replace absent or near‑absent meniscal tissue for symptomatic, activity‑limiting knee pain following prior meniscectomy. Coverage is intended for younger, active adults typically too young for total knee arthroplasty (generally <55) who have failed conservative therapy, have minimal surrounding cartilage degeneration (Outerbridge grade II or less), normal or correctable alignment and stability, BMI ≤35, no infection or inflammatory arthritis, and—when indicated—may be performed concurrently or sequentially with specified focal cartilage procedures. Exclusions/limitations include candidates for TKA, patients with substantial remaining meniscus, diffuse osteoarthritis or ≥50% joint space narrowing, uncorrectable malalignment/instability, BMI >35, use of unproven implant materials, and coverage is subject to the member’s benefit plan.

"Prior meniscectomy with persistent symptoms on the affected side."