Surgery of the Knee – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers knee surgeries (arthroscopy, arthrotomy, and total/partial knee replacement) as medically necessary when InterQual procedure‑specific criteria are met, but multiple articular cartilage repair techniques — including autologous/allogeneic minced or particulated cartilage (e.g., CAIS), BioCartilage®, DeNovo grafts, collagen meniscus implants, decellularized osteochondral allografts, reduced osteochondral discs, synthetic resorbable polymers, and xenografts — are considered unproven and not medically necessary. Medical records and a complete diagnostic imaging interpretation (relevant clinical information, detailed findings, impression, and interpreter specialty) may be required for review, and final coverage is determined by the member’s benefit plan.

"Surgery of the knee is proven and medically necessary in certain circumstances (see InterQual® CP: Procedures)."