CurrentBlue Cross Blue Shield - IowaPolicy 07.01.65

Osteochondral Allografts and Autografts in the Treatment of Focal Articular Cartilage Lesions

Defines medical necessity and investigational indications for osteochondral autografts (OATS/mosaicplasty) and fresh osteochondral allografts for focal full-thickness articular cartilage lesions of the knee, ankle (talus), elbow, and shoulder for members and providers.

Policy Summary

PayerBlue Cross Blue Shield - Iowa

PolicyOsteochondral Allografts and Autografts in the Treatment of Focal Articular Cartilage Lesions

Policy CodePolicy 07.01.65

Change TypeNo material clinical or coverage changes in this revision

Effective DateMay 1, 2014

Next Review DateJun 1, 2025

Key ActionDocument lesion size/volume, prior conservative treatments (≥3 months), prior cartilage procedures, and rationale for autograft versus allograft when requesting coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1–2.5 cm^2Knee covered lesion size

>1.5 cm^2Talar large lesion threshold

>3.0 cm^3Cystic lesion volume threshold

3 monthsRequired failed conservative therapy

82% at 10 yr

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Graft survival (10 yr)

Coverage Criteria for Osteochondral Autograft and Allograft Procedures

Indications (large/cystic lesions or failed marrow stimulation)

Osteochondral autografting (OATS/mosaicplasty) and fresh osteochondral allografting may be considered medically necessary for large or cystic lesions of the talus or for lesions that have failed prior marrow stimulation when specific criteria are met.

ALL of the following

Lesion characteristics: Large lesion defined as area > 1.5 cm^2 (150 mm^2) OR cystic lesion defined as volume > 3.0 cm^3 (3000 mm^3).
Size thresholds derived from studies showing lower success with marrow stimulation for lesions ≥1.5 cm^2; large/cystic lesions less likely to respond to microfracture.
Prior treatment: Either primary large/cystic lesion where marrow stimulation or autograft would be inadequate due to lesion size/depth/location, OR revision surgery after failed prior marrow stimulation (e.g., microfracture, drilling).
Marrow stimulation is generally effective for lesions <1.5 cm^2; failure rates increase for larger lesions.
Patient factors: Individual is skeletally mature with documented closure of growth plates; absence of inflammatory arthritis or other systemic disease affecting the joint; pain impacts activities of daily living (ADLs).
Skeletal maturity and absence of systemic joint disease are required for consideration.
Conservative therapy: Individual has failed an adequate trial (typically ≥3 months) of conservative measures including physical therapy or home exercise program, anti-inflammatory medications/analgesics, adjunctive medications as appropriate (eg, neuropathic agents, muscle relaxants), and consideration of intraarticular corticosteroid injection(s).
Exception to PT requirement allowed if clearly documented (eg, intractable pain preventing PT).
Joint status and biomechanics: Documented minimal to absent degenerative changes in surrounding articular cartilage and joint biomechanics/alignment and stability are normal or are corrected concurrently (eg, ligament/tendon repair, osteotomy).
Misalignment and instability are contraindications unless corrected at time of grafting.
Donor-site considerations: For autograft, donor-site morbidity and feasibility of obtaining adequate autograft volume must be considered; when autograft would cause substantial donor-site morbidity or is inadequate, fresh allograft may be appropriate.
Allograft use may impact future arthroplasty/arthrodesis; fresh (not frozen) ankle-source allografts are preferred per expert consensus.

Procedure and Threshold Coding Guidance

Procedure CPT CodesCPT

24999	Unlisted procedure, humerus, or elbow.
27415	Osteochondral allograft, knee, open.
27416	Osteochondral autograft(s), knee, open (e.g., mosaicplasty) (includes harvesting of autograft[s]).
27899	Unlisted procedure, leg or ankle.
28446	Open osteochondral autograft, talus (includes obtaining graft[s]).
29866	Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft[s]).
29867	Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty).
29885	Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion).
29892	Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy).
29999	Unlisted procedure, arthroscopy.

Procedure CPT codes referencedCPT

24999	Unlisted procedure, humerus, or elbow
27415	Osteochondral allograft, knee, open
27416	Osteochondral autograft(s), knee, open (e.g., mosaicplasty) (includes harvesting of autograft[s])
27899	Unlisted procedure, leg or ankle
28446	Open osteochondral autograft, talus (includes obtaining graft[s])
29866	Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft[s])
29867	Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty)
29885	Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)
29892	Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy)
29999	Unlisted procedure, arthroscopy

No explicit CPT/HCPCS/ICD-10 codes listed in this sectionmixed

No codes listed

Lesion size/volume thresholds — knee and talus

Knee autograft lesion area1–2.5 cm^2 (focal, full-thickness femoral condyle/trochlea/patella lesions)

Talus large lesion area>1.5 cm^2 (threshold where marrow-stimulation outcomes decline)

Cystic lesion volume>3.0 cm^3 (cystic talar lesions considered large/candidate for grafting)

Lesion size/volume thresholds — knee and talus details

Knee lesion typical size range for autograftExamples cited: optimal/typical ranges ~1–4 cm^2 or 2–6 cm^2 for medium-size lesions; best results in narrow range

Talus large lesion definition

Prior Authorization, Documentation, and Billing Actions

Prior Authorization

Prior Authorization Applicability and Denial Triggers

Prior authorization: Procedures that do not meet the specified clinical criteria (for example, fresh osteochondral allograft or osteochondral autografting for lesions and joints not described in the indications, or for lesion sizes/characteristics outside the stated thresholds) are subject to denial as investigational or not medically necessary.

Procedures not meeting the policy’s specified indications (e.g., allograft for small primary ankle lesions <1.5 cm2 without documented inadequacy of marrow stimulation) may be denied.
Use of investigational products (autologous/allogeneic minced cartilage, decellularized allograft plugs, reduced osteochondral discs) is considered investigational and may be denied.

Documentation Required

Evidence and Study Selection Considerations

Prior authorization and medical necessity review require documentation that studies submitted do not represent duplicative or overlapping patient populations. Studies or registries that include the same patients or cohorts without clear separation may not support medical necessity.

Definitions and Classification

Osteochondral autograft (OATS/mosaicplasty) definition

Osteochondral autograft (OATS/mosaicplasty)Harvesting one or more small osteochondral plugs from non-weight-bearing sites (usually knee) and press-fitting them into the prepared lesion site

Therapeutic intentUsed to repair focal full-thickness chondral defects using the patient’s own osteochondral tissue

Typical donor siteNon–weight-bearing regions of the ipsilateral knee

Fresh osteochondral allograft definition

Fresh osteochondral allograftTransplantation of donor osteochondral tissue to replace injured cartilage and subchondral bone; used for larger lesions when autograft is inadequate

Indications summaryConsidered for large (>1.5 cm^2) or cystic (>3.0 cm^3) talar lesions and large/deep knee defects when other repairs are inadequate

Policy Revision History

2025-06administrativeLatest

Annual review and policy renewal completed (June 2025).

2024-08administrative

Annual review and policy renewed (August 2024).

2023-08administrative

Policy Summary

PayerBlue Cross Blue Shield - Iowa

PolicyOsteochondral Allografts and Autografts in the Treatment of Focal Articular Cartilage Lesions

Policy CodePolicy 07.01.65

Change TypeNo material clinical or coverage changes in this revision

Effective DateMay 1, 2014

Next Review DateJun 1, 2025

Key ActionDocument lesion size/volume, prior conservative treatments (≥3 months), prior cartilage procedures, and rationale for autograft versus allograft when requesting coverage.

SourceLink

On This Page

Area >1.5 cm^2 or cystic volume >3.0 cm^3 — indicates consideration for autograft or allograft

Marrow-stimulation suitabilityLesions <1.5 cm^2 (or <3.0 cm^3) are generally appropriate for marrow stimulation (microfracture) rather than autograft/allograft

Lesion size — typical ranges and indications for autograft/allograft

Autograft typical effective rangeMost effective for medium-size knee lesions roughly 2–6 cm^2 (other sources cite 1–4 cm^2 examples)

When to favor allograftAllograft commonly indicated for lesions >2 cm^2 or when autograft volume is inadequate (series include lesions up to 27 cm^2)

Factors affecting graft choiceLesion location (femoral condyles best), patient age/sex, and donor-site morbidity influence autograft vs allograft selection

Lesion area threshold (1.5 cm2)

Lesion area threshold1.5 cm^2

Clinical implicationArea ≥1.5 cm^2 cited as threshold where marrow-stimulation outcomes decline for talar lesions

Use recommendationConsider osteochondral grafting (autograft or allograft) when lesion area exceeds this threshold

Cyst volume threshold (3.0 cm3)

Cyst volume threshold3.0 cm^3

Clinical implicationCystic lesions >3.0 cm^3 of the talus are considered large/cystic and may warrant osteochondral grafting

Use recommendationWhen cyst volume exceeds this threshold and autograft is inadequate, fresh allograft may be considered

Lesion size and cyst volume thresholds (summary)

Summary thresholdsArea >1.5 cm^2 OR cystic volume >3.0 cm^3 indicate large/cystic talar lesions warranting consideration of grafting

Knee threshold reminderKnee autograft indicated for focal full-thickness lesions sized 1–2.5 cm^2

Marrow-stimulation noteMarrow stimulation preferred for lesions smaller than these thresholds

Lesion area threshold (>1.5 cm2 for large lesions)

Large lesion area definition>1.5 cm^2 (noted as threshold for 'large' talar lesions)

Evidence contextSystematic reviews and series report poorer microfracture outcomes above this area and improvement after grafting

Clinical actionDocument lesion area when requesting authorization for graft procedures

Cystic lesion volume threshold (>3.0 cm3)

Large cystic lesion volume>3.0 cm^3 (cystic talar lesions considered large; examples of much larger volumes reported in series)

Clinical outcomesStudies report improvement after grafting for large cystic lesions but higher reoperation/nonunion rates in some series

Authorization noteDocument cyst volume when justifying grafting or allograft use

Lesion size thresholds — ankle definitions

Ankle large/cystic lesion thresholdsArea >1.5 cm^2 OR cyst volume >3.0 cm^3 — criteria for considering autograft or fresh allograft when autograft inadequate

Knee distinctionKnee autograft typically for 1–2.5 cm^2 focal lesions; larger knee lesions often managed with allograft

Clinical precedenceMarrow stimulation is preferred for small lesions; grafting used for larger or failed cases

Follow-up duration expectations

Minimum follow-up for outcome assessmentAt least 6 months (recommended) with reporting of pre- and postoperative scores

Ankle long-term follow-upFollow-up of 5 years or longer is recommended for ankle allograft outcome assessment

Elbow follow-up guidanceFollow-up ≥6 months or until return to activity recommended for elbow cases; longer follow-up preferred

Lesion area threshold for considering grafting (>1.5 cm2)

Area threshold to consider grafting>1.5 cm^2 — used to triage talar lesions away from marrow stimulation toward grafting

Supporting evidenceDerived from studies showing higher failure rates of microfracture above this area

Documentation requirementRecord lesion measurements (area) when applying for authorization

Cyst volume threshold for considering grafting (>3.0 cm3)

Cyst volume threshold to consider grafting>3.0 cm^3 — cystic talar lesions above this volume considered for grafting

Clinical implicationLarge cystic lesions less likely to respond to marrow stimulation; grafting may improve outcomes

Authorization noteDocument cyst volume and prior treatments when requesting allograft

Lesion surface area threshold (>150 mm2)

Surface area threshold>150 mm^2 (equivalent to 1.5 cm^2) — cited as the threshold where microfracture outcomes decline for OLTs)

Clinical evidenceMultiple studies report good outcomes with microfracture for lesions <150 mm^2 and poor outcomes for >150 mm^2

Actionable pointConsider osteochondral grafting for lesions exceeding this surface area

Large cystic lesion definition (surface area >150 mm2 or volume >3000 mm3)

Large cystic lesion definitionSurface area >150 mm^2 OR volume >3000 mm^3 (3000 mm^3 = 3.0 cm^3)

Clinical rationaleArthroscopic marrow-stimulation techniques are unreliable for such lesions; grafting (autograft or allograft) recommended

Evidence examplesProspective series report clinical improvement in many large-volume cystic cases though with some graft resorption and reoperations

Exclude duplicative or overlapping studies when relying on literature to support coverage requests.
If study cohorts overlap, provide clarifying documentation distinguishing patient populations or provide individual patient clinical records to support medical necessity.

Documentation Required

Required Documentation: Lesion Size, Location, and Grade

Clinical documentation submitted for prior authorization must support lesion size, location, and grade. Include explicit lesion measurements and relevant imaging or operative findings to demonstrate that the patient meets the size/volume thresholds cited in the policy.

Lesion measurements: area in cm2 and/or volume in cm3 (e.g., area >1.5 cm2 or volume >3.0 cm3 for talar lesions).
Lesion location and Outerbridge grade (e.g., full-thickness/Outerbridge Grade III–IV).
Skeletal maturity status (documented growth plate closure) when applicable.

Documentation Required

Long-term Outcomes and Follow-up Documentation

Long-term outcomes and follow-up data are required to evaluate procedure effectiveness. For knee procedures, submit or plan for 5- to 15-year follow-up when available; for ankle and certain other joints, submit follow-up of at least 3–5 years or longer as recommended in the policy.

Knee: long-term outcomes recommended 5–15 years.
Ankle: follow-up typically ≥3–5 years; for some indications follow-up ≥5 years preferred.
Include validated outcome scores (e.g., Lysholm, AOFAS, VAS, SF-12/36) at baseline and follow-up time points.

Documentation Required

Required Documentation: Prior Procedures and Conservative Therapy

Document prior procedures and treatments clearly. Provide operative reports, dates, and outcomes for prior marrow-stimulation procedures (e.g., microfracture, drilling), debridement, or prior grafting, and explain failure or inadequacy of prior treatments.

List prior surgical procedures with dates and operative summaries (microfracture, drilling, abrasion arthroplasty, prior autograft/allograft).
Describe prior nonoperative therapies and duration (≥3 months conservative therapy including PT, home exercise, medications, injections).
If debridement alone was performed, note consideration of marrow-stimulation techniques and rationale for proceeding to grafting.

Documentation Required

Document Rationale Why Marrow-Stimulation or Autograft Are Inadequate

When requesting an allograft or autograft after marrow stimulation, providers should document why marrow-stimulation or autograft approaches are inadequate for the individual patient (for example, lesion size, depth, location, prior failed marrow stimulation, or donor-site morbidity concerns).

Explain why primary marrow stimulation is not appropriate (e.g., lesion area >1.5 cm2 or cystic volume >3.0 cm3, anatomic location not amenable to marrow stimulation).
For allograft requests, document why autograft would be inadequate or cause unacceptable morbidity (e.g., insufficient donor tissue, lesion too large/deep, involvement of talar shoulder).
For revision procedures, include documentation of failed prior marrow stimulation (operative notes, imaging, and clinical course).

Evidence noteSystematic reviews report improved scores and long-term graft survival in selected series

Skeletally mature definition

Skeletally matureDocumented closure of the growth plates; required for listed indications for autograft/allograft in adolescents

Why relevantPolicy requires skeletal maturity for talus and certain indications to avoid growth-plate complications

DocumentationImaging or clinical record documenting growth plate closure should be provided

Kellgren-Lawrence Grading System

Kellgren-Lawrence Grading SystemRadiographic grading for knee osteoarthritis from Grade 0 (none) to Grade IV (severe changes)

Use in policyHelps document extent of degenerative change; minimal-to-absent degenerative changes (Grade II or less) preferred for autograft candidacy

Grades overviewGrade I–IV classifications describe progressive OA features on plain radiographs

Kissing Lesion definition

Kissing LesionArticular cartilage defects on opposing joint surfaces that contact each other (bipolar lesion)

Clinical implicationKissing (bipolar) lesions may affect candidacy for focal grafting techniques

AssessmentIdentified by imaging or intraoperative inspection

Outerbridge / Modified Outerbridge Classification

Outerbridge / Modified Outerbridge ClassificationDescriptive grading of cartilage injury from Grade I (softening) to Grade IV (exposed subchondral bone)

Policy usePolicy refers to full-thickness lesions as Outerbridge Grade III–IV for graft candidacy

ApplicationUsed intraoperatively or via imaging to classify lesion severity

Autologous osteochondral transplantation (definition variant)

Autologous osteochondral transplantation (variant)Removal of injured cartilage and underlying bone and replacement with graft harvested from another area of the patient; implanted chondrocytes may retain hyaline properties

Alternate nameAlso described as OATS or mosaicplasty when multiple small plugs are used

Expected benefitDurable hyaline cartilage restoration compared with fibrocartilage from marrow stimulation

Fresh osteochondral allograft (definition variant)

Fresh osteochondral allograft (variant)Donor osteochondral tissue transplanted to replace injured cartilage and bone; preferred fresh (not frozen) for ankle according to consensus

Use caseUsed when autograft inadequate due to lesion size, depth, or location

Source guidanceInternational consensus recommends ankle allograft source from ankle, not knee

Autologous osteochondral transplantation (additional)

Autologous osteochondral transplantation (additional)Implanted graft chondrocytes may preserve hyaline cartilage properties and improve durability over fibrocartilage

Technique noteMultiple small plugs (mosaicplasty) can be used to fill larger defects

Donor-site considerationHarvesting from knee may cause donor-site morbidity that influences graft choice

Lesion size thresholds (small <1.5 cm2; large >=1.5 cm2)

Small lesion thresholdSmall: <1.5 cm^2 — marrow stimulation preferred

Large lesion thresholdLarge: ≥1.5 cm^2 or cystic (>3.0 cm^3) — consider autograft/allograft

Policy implicationThresholds guide selection between microfracture and grafting techniques

Large lesion definition (area >1.5 cm2)

Large lesion definitionArea >1.5 cm^2 — cited threshold where marrow-stimulation outcomes decline and grafting considered

Clinical consequenceApproximately 20% of talar lesions are too large for marrow stimulation

DocumentationReport lesion area when seeking authorization for grafting

Cystic lesion definition (volume >3.0 cm3)

Cystic lesion definitionVolume >3.0 cm^3 (3,000 mm^3) — indicates cystic full-thickness cartilage lesion

Clinical relevanceCystic change increases likelihood of marrow-stimulation failure and may prompt grafting

Measurement noteCyst volume should be documented on imaging when possible

Marrow stimulation definition

Marrow stimulation (microfracture)Debridement and puncture of subchondral bone to stimulate fibrocartilage formation; standard comparator for small lesions

When preferredPreferred primary therapy for small talar lesions (<1.5 cm^2)

LimitationsLess durable fibrocartilage and poorer outcomes in larger or cystic lesions

Small (primary) full-thickness ankle lesion

Small (primary) full-thickness ankle lesionLesion area <1.5 cm^2 — microfracture typically effective as primary treatment

Treatment implicationAutograft not generally indicated as primary therapy for these small lesions

EvidenceMultiple studies report high success with marrow stimulation for these lesions

Large or cystic ankle lesion

Large or cystic ankle lesionLesion area >1.5 cm^2 OR cystic volume >3.0 cm^3; scenarios where autograft may be inadequate and fresh allograft considered

Clinical rationaleLarge/cystic lesions have poorer microfracture outcomes and may need grafting; autograft may be limited by donor volume morbidity

Authorization noteDocument lesion size/volume and prior treatments when justifying allograft

fresh osteochondral allograft (definition restated)

Fresh osteochondral allograft (restated)Donor cartilage and bone implanted to replace injured tissue; favored for larger defects or salvage when autograft inadequate

Preferred freshnessConsensus prefers fresh (not frozen) allografts for ankle use

Source preferenceAnkle-sourced grafts preferred for ankle lesions (not knee source)

autologous osteochondral transplantation (definition restated)

Autologous osteochondral transplantation (restated)Removal of injured cartilage and bone replaced with patient's own graft (OATS/mosaicplasty); NICE supports use for knee defects

Technique noteMosaicplasty uses multiple small plugs to fill defects

Expected benefitPotentially more durable hyaline cartilage repair than marrow stimulation

Autologous osteochondral transplantation (additional restatement)

Autologous osteochondral transplantation (additional restatement)Implanted autologous graft chondrocytes may retain hyaline characteristics; donor-site morbidity is a consideration

Clinical considerationsYounger patients and lesions on femoral condyles show better outcomes

Size considerationsMost effective in a relatively narrow lesion size range (examples 1–6 cm^2)

Minced/particulated cartilage transplantation definition

Minced/particulated cartilage transplantationMechanical fragmentation of cartilage into 1–2 mm pieces to release chondrocytes and implant into defect

Evidence statusLimited to small RCTs and case series with mixed imaging and durability findings

Clinical roleBeing evaluated as an alternative to grafting or marrow stimulation in select lesions

Decellularized osteochondral allograft plug definition

Decellularized osteochondral allograft plugAllograft processed to remove cells/lipids and sterilized to extend shelf life

Evidence noteCase series report high failure and delamination rates (eg, Chondrofix concerns)

Coverage stanceConsidered investigational in policy due to limited/negative evidence

Particulated/minced cartilage definition

Particulated/minced cartilageCartilage tissue minced into small pieces (autologous or juvenile allograft) and implanted to fill focal chondral defects

Technique aspectsOften fixed with fibrin glue or scaffold; many series include concomitant procedures

EvidenceLimited case series show functional improvements but MRI abnormalities and graft hypertrophy/delamination reported

Reduced osteochondral allograft discs definition

Reduced osteochondral allograft discsLaser-etched discs containing hyaline cartilage with chondrocytes, growth factors, and extracellular matrix proteins used to treat full-thickness lesions

Evidence statusLimited to small case series; insufficient to draw efficacy conclusions

Policy implicationConsidered investigational pending stronger evidence

Marrow stimulation (microfracture) definition

Marrow stimulation (microfracture)Debridement and puncturing of subchondral bone to stimulate fibrocartilage repair; standard comparator therapy for small lesions

Clinical limitationLess durable fibrocartilage; poorer results in larger or cystic lesions

Preferred usePrimary treatment for small talar lesions (<1.5 cm^2)

Mosaicplasty (osteochondral autograft transfer)

Mosaicplasty (osteochondral autograft transfer)Autologous technique using multiple small osteochondral plugs to repair focal cartilage defects (mosaic pattern)

GuidanceNICE IPG607 supports use of mosaicplasty for symptomatic knee cartilage defects

Typical donor siteNon-weight-bearing regions of the knee

Osteochondral allograft general definition

Osteochondral allograft (general)Transplantation of donor osteochondral tissue to repair focal cartilage and subchondral bone defects; used for larger lesions or salvage

Clinical outcomesSystematic reviews report improved functional scores and long-term graft survival in selected knee/allograft series

Coding notePolicy lists specific CPT codes for reporting these procedures

OLT (Osteochondral lesion of the talus)

OLT (Osteochondral lesion of the talus)Focal cartilage and subchondral bone defect of the talus; lesion surface area >150 mm^2 cited as threshold where marrow-stimulation outcomes decline

Clinical relevanceLarge OLTs (>150 mm^2) often require grafting rather than microfracture

Measurement units150 mm^2 = 1.5 cm^2

Large cystic lesion definition (surface area >150 mm2 or volume >3000 mm3)

Large cystic lesion definition (restated)Surface area >150 mm^2 OR volume >3000 mm^3 (3.0 cm^3) — used in evidence and consensus to denote large/cystic talar lesions

Clinical consequenceMarrow stimulation unreliable for these lesions; grafting (autograft or allograft) recommended

Evidence exampleProspective series (Raikin) reported good/excellent results in many very large-volume cases

Failed primary arthroscopic treatment

Failed primary arthroscopic treatmentPersistent or recurrent symptoms after arthroscopic debridement/microfracture where repeat arthroscopy often gives short-lived results; may prompt grafting consideration

Clinical actionRevision autograft or allograft considered after failed marrow stimulation for large or cystic lesions

DocumentationRecord prior procedures and failures when requesting authorization for revision grafting

Annual review and policy revised (August 2023).

2022-08administrative

Annual review and policy revised (August 2022).

2021-08administrative

Annual review and policy revised (August 2021).

2020-08administrative

Annual review and policy revised (August 2020).

2019-08administrative

Annual review and policy revised (August 2019).

2018-08administrative

Annual review and policy revised (August 2018).

2017-08administrative

Annual review and policy revised (August 2017).

2016-08administrative

Annual review and policy revised (August 2016).

2015-09administrative

Annual review and policy revised (September 2015).

2014-10administrative

Interim review and policy revised (October 2014).

2014-05-01administrative

New medical policy created (effective May 1, 2014).