Summary & Overview

CPT 29868: Arthroscopic Meniscal Repair with Cartilage Implantation

CPT code 29868 represents an arthroscopic knee procedure to inspect, debride, and repair a damaged meniscus, including implantation of healthy donor cartilage. This procedure addresses meniscal tears that cause pain and limited motion and is an important component of orthopedic surgical care for joint preservation. Nationally, coding and coverage for meniscal repair procedures affect surgical utilization, patient access to joint-preserving treatments, and post-acute care pathways.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of typical coverage considerations, coding context, common modifiers used with this service, and clinical indications that align with the code description. The publication also summarizes benchmarks and policy-relevant issues that influence authorization, coverage criteria, and site-of-service decisions for arthroscopic meniscal repair with cartilage implantation.

The content serves clinicians, coding professionals, and policy analysts by clarifying the clinical intent of CPT code 29868, outlining typical sites of service, and identifying areas where payer policy and documentation practices commonly intersect with coding for meniscal repair procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare29868CPTarthroscopymeniscal repairknee surgeryorthopedicsambulatory surgeryoutpatient surgery

Billing Code Overview

CPT code 29868 describes an arthroscopic procedure to inspect and repair a damaged meniscus inside the knee joint. The provider uses an arthroscope to examine the joint, insert instruments to incise and remove damaged cartilage, and implant healthy donor cartilage to restore the meniscal surface.

Service type: Arthroscopic meniscal repair with allograft cartilage implantation
Typical site of service: Ambulatory surgical center or hospital outpatient surgical department

Clinical & Coding Specifications

Clinical Context

A 34-year-old active patient presents with progressive lateral knee pain, intermittent swelling, and mechanical locking after a twisting injury sustained while playing soccer three months ago. Physical examination demonstrates joint line tenderness and a positive McMurray test. MRI of the knee shows a complex tear of the lateral meniscus with symptomatic cartilage loss in the lateral femoral condyle. Nonoperative management including activity modification, physical therapy, and NSAIDs provided limited relief.

The orthopedic surgeon schedules an arthroscopic procedure for diagnostic evaluation and treatment. In the operating room, standard arthroscopic portals are created. The provider inserts an arthroscope to inspect the synovium, articular cartilage, and meniscal surfaces. Damaged meniscal tissue is debrided and unstable fragments removed. A meniscal repair is attempted where tissue quality allows; in an area of focal chondral defect the surgeon implants fresh osteochondral allograft or minced donor cartilage into the defect and secures it arthroscopically. Typical intraoperative steps include diagnostic arthroscopy, irrigation, mechanical debridement, selective meniscectomy or repair, cartilage preparation, graft insertion, and fixation as indicated. Postoperative care includes regional block or multimodal analgesia, dressing and knee immobilizer as needed, early supervised rehabilitation with protected weight-bearing and range-of-motion progression, and follow-up visits for wound check and physical therapy guidance.

Service Type: Procedure (arthroscopic knee meniscus repair with cartilage grafting).

Typical Site of Service: Hospital outpatient surgical suite or Ambulatory Surgery Center.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, and effort significantly exceed what is typical for `29868`.
`52`	Reduced services	Use when the service is partially reduced or not completed as originally planned (e.g., aborted after diagnostic arthroscopy).
`53`	Discontinued procedure	Use when the procedure is terminated for patient safety before completion.
`59`	Distinct procedural service	Use when a separate, distinct procedure is performed at a separate anatomic site or session from `29868`.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the same `29868` procedure.
`63`	Procedure performed on infants less than 4 kg	Rare for knee arthroscopy; use only when applicable.
`66`	Surgical team (team approach)	Use when a surgical team approach is required for `29868`.
`78`	Return to the operating room for a related procedure following initial procedure on the same day	Use when a related, previously performed `29868` requires a same-day return to the OR.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when a distinct, unrelated procedure is performed during the global period of `29868`.
`RT`	Right side	Use to indicate the procedure was performed on the right knee.
`LT`	Left side	Use to indicate the procedure was performed on the left knee.
`AS`	Ambulatory Surgery Center (payment identification)	Use to identify services furnished in an ASC when billing payors that require the modifier.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Use when reporting anesthesia services associated with `29868` and medical direction criteria are met.
`TC`	Technical component	Use when billing only the technical component of services (imaging or device charge) associated with the procedure, if applicable.

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty performing arthroscopic meniscal repair and cartilage restoration.
`207L00000X`	Sports Medicine (Orthopaedic Surgery)	Subspecialty focused on arthroscopic knee procedures in athletes.
`2080S0121X`	Physical Medicine & Rehabilitation	Involved in postoperative rehabilitation and nonoperative management decisions.
`2086S0122X`	Pain Management	May provide regional anesthesia or postoperative pain interventions.
`207K00000X`	General Surgery	Occasionally involved in surgical care coordination in smaller centers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M23.2`	Internal derangement of knee, meniscal tear	Direct indication for arthroscopic meniscal evaluation and repair or partial meniscectomy.
`S83.241A`	Complex tear of lateral meniscus, current injury, right knee, initial encounter	Acute traumatic meniscal tear often treated with arthroscopic repair or debridement and possible cartilage work.
`S83.242A`	Complex tear of lateral meniscus, current injury, left knee, initial encounter	As above for the left knee.
`M17.11`	Unilateral primary osteoarthritis, right knee	Degenerative changes with meniscal and chondral injury prompting arthroscopic assessment and cartilage restoration procedures.
`M17.12`	Unilateral primary osteoarthritis, left knee	As above for the left knee.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29870`	Arthroscopy, knee, surgical; meniscectomy (medial OR lateral including any meniscal shaving)	Performed when meniscal debridement/removal is required rather than repair; may be an alternative intraoperative service to parts of `29868`.
`29881`	Arthroscopy, knee, surgical; synovectomy, major (more than just shaving)	Performed when significant synovial disease is encountered during the diagnostic arthroscopy in the same session as `29868`.
`27447`	Arthroplasty, knee, condyle and plateau; medial OR lateral compartment	May be performed in the same patient in staged care when cartilage restoration or meniscal repair fails and joint replacement is indicated; not performed same operative session typically.
`29875`	Arthroscopy, knee, surgical; lateral meniscus repair	Specific meniscal repair code that may be reported when isolated meniscal repair is performed; relates directly to the meniscal repair component of `29868` depending on payer guidance.
`27446`	Arthroplasty, knee, condyle and plateau; medial AND lateral compartments	Related as a potential subsequent treatment option for advanced joint degeneration following failed cartilage restoration or recurrent meniscal pathology.