Summary & Overview
HCPCS G0428: Collagen Meniscus Implant for Meniscal Defects
HCPCS Level II code G0428 denotes a collagen meniscus implant procedure — an operative orthopedic service using a collagen scaffold to fill meniscal defects and restore meniscal function. The code captures an emerging surgical implant technique that can affect care pathways for patients with meniscal loss or irreparable tears and is relevant for hospital outpatient departments and ambulatory surgery centers. Nationally, tracking use of G0428 matters for surgical utilization, implant supply chain, and payer coverage policy development.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for collagen meniscus implants, typical sites of service, common billing modifiers, and payer coverage considerations. The publication provides benchmarks where available, summarizes relevant policy updates affecting implant and outpatient surgery reimbursement, and highlights billing and documentation elements that frequently affect claim adjudication. Intended for billing professionals, orthopedic providers, and policy analysts, the content supports operational and payer-policy decision making for meniscal implant services.
Billing Code Overview
HCPCS Level II code G0428 describes a collagen meniscus implant procedure used to fill meniscal defects, commonly referenced as a collagen scaffold or products such as Menaflex. The procedure is a surgical orthopedic implant service performed to restore meniscal volume and function after meniscal loss or irreparable meniscal tears.
Typical site of service: hospital outpatient department or ambulatory surgery center, where orthopedic soft-tissue repair and implant procedures are performed.
Service type: operative orthopedic implant/meniscal reconstruction using a collagen scaffold to fill meniscal defects.
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Clinical & Coding Specifications
Clinical Context
A 36-year-old active patient presents with persistent medial knee pain and mechanical symptoms (catching, intermittent locking) six months after a prior partial medial meniscectomy. MRI demonstrates a symptomatic meniscal defect of the medial meniscus with insufficient native tissue to repair and localized chondral preservation. After conservative management (physical therapy, activity modification, intra-articular injections) fails, the orthopedic surgeon schedules an arthroscopic collagen meniscus implant procedure to fill the meniscal defect and restore load distribution.
The clinical workflow includes preoperative evaluation and imaging review, informed consent discussing risks and alternatives (including partial meniscectomy revision vs. scaffold implantation), same-day arthroscopic implantation of the collagen scaffold (e.g., CMI, Collagen Scaffold, Menaflex) with fixation as indicated, intraoperative documentation of defect size and fixation method, post-anesthesia recovery, and a supervised rehabilitation plan with protected weightbearing and progressive range-of-motion and strengthening phases. Typical site of service is an ambulatory surgery center or hospital outpatient department under general or regional anesthesia. Documentation must support medical necessity, laterality, operative details (implant type, size, fixation), and any applicable modifiers for professional or facility billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure |