CurrentBluecross IdahoPolicy MP 7.01.15

Meniscal Allografts and Other Meniscal Implants

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Defines medical necessity criteria and coverage stance for meniscal allograft transplantation (MAT) and states that other meniscal implants (e.g., collagen scaffolds) are investigational; applies to Blue Cross of Idaho benefit plans and providers evaluating coverage for members.

Policy Summary

PayerBluecross Idaho

PolicyMeniscal Allografts and Other Meniscal Implants

Policy CodePolicy MP 7.01.15

Change TypeNo material change

Effective DateApr 30, 2026

Last ReviewApr 30, 2026

Next Review DateApr 30, 2026

Key ActionObtain prior authorization per plan procedures and document prior meniscectomy, symptomatic meniscus deficiency (>50% absent), failed conservative therapy, cartilage status, and correction of alignment/instability when applicable.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

<55 yrsTypical max age for MAT candidacy

>50%Meniscal absence threshold

BMI >35Obesity level noted

0.24/100kEstimated annual incidence (privately insured)

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CurrentBluecross IdahoPolicy MP 7.01.15

Meniscal Allografts and Other Meniscal Implants

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Policy Summary

PayerBluecross Idaho

PolicyMeniscal Allografts and Other Meniscal Implants

Policy CodePolicy MP 7.01.15

Change TypeNo material change

Effective DateApr 30, 2026

Last ReviewApr 30, 2026

Next Review DateApr 30, 2026

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

<55 yrsTypical max age for MAT candidacy

>50%Meniscal absence threshold

BMI >35Obesity level noted

0.24/100kEstimated annual incidence (privately insured)

9.9 yrsMean allograft survival (reported)

2010 NCDMedicare noncoverage for CMI

Coverage Criteria for Meniscal Allograft Transplantation and Meniscal Implants

Meniscal allograft transplantation (MAT) coverage

Covered when ALL of the following are met

MAT medical necessity criteria: Adult individual too young to be considered an appropriate candidate for total knee arthroplasty or other reconstructive knee surgery (e.g., <55 years)age

from policy

Refractory symptoms: Disabling knee pain with activity that is refractory to conservative treatmentclinical

from policy

Meniscal deficiency: Absence or near absence (>50%) of the meniscus established by imaging or prior surgery>50%

from policy

Cartilage status: Documented minimal to absent diffuse degenerative changes in surrounding articular cartilage (e.g., Outerbridge grade II or less, <50% joint space narrowing)Outerbridge II or less / <50% JSN

from policy

Knee biomechanics: Normal knee biomechanics or alignment and stability achieved concurrently with meniscal transplantationcorrected alignment/stability

from policy

MAT combined with cartilage restoration

Covered when ALL of the following are met and performed in combination with MAT

Concomitant cartilage procedures: MAT may be considered medically necessary when performed concurrently or sequentially with treatment of focal articular cartilage lesions using autologous chondrocyte implantation, osteochondral allografting, or osteochondral autograftingprocedures specified

from policy

Coverage scope

Coverage considerations focus on individuals undergoing partial meniscectomy who may receive MAT or CMI as an alternative to or in addition to standard care.

PICO scope: Population: individuals undergoing partial meniscectomy; Intervention: MAT or other meniscal implants (e.g., collagen); Comparator: partial meniscectomy without MAT; Outcomes: pain, functional outcomes, quality of life measured over 1-10 years.

From clinical context and outcomes sections.

Evidence considerations

Evidence summary informing coverage decisions

Evidence quality and outcomes: Available evidence for MAT combined with cartilage repair is limited and low-quality (case series, historical controls); studies report improvements from baseline but also graft failures and frequent additional surgeries.

Systematic reviews and case series summarized.

Coverage considerations for CMI

Consider CMI as an option when accompanying partial meniscectomy; assess evidence and patient factors:

Evidence base and study quality: Systematic reviews and some RCTs/observational studies report improvements in pain and function after CMI, but the overall quality of evidence is low and many studies are case series.

Supports cautious use; consider need for documentation of expected benefit

Outcomes observed: Some systematic reviews and studies reported superior clinical outcomes versus partial meniscectomy alone in certain analyses, but results are heterogeneous and imaging often shows implant volume loss or destruction.

Weigh symptomatic/functional gains against implant durability concerns

Long-term data: Some studies report long-term (>10 year) follow-up with sustained symptom/function improvements, but data primarily from lower-quality designs.

Document long-term expectations with patients

MAT — single-compartment symptomatic meniscus deficiency

Covered when evidence supports benefit in selected patients

MAT effectiveness summary: Systematic reviews, case series, and limited RCT data report statistically significant improvements in pain and function with MAT and sustained benefits in some cohorts (>10 years); evidence is limited by study design but sufficient to determine improvement in net health outcome for selected patients.

MAT with concomitant procedures

Covered when performed with correction of contributing pathology

MAT + concomitant repair: When MAT is performed with correction of malalignment, repair of focal chondral defects, or reconstruction of ligamentous insufficiency, systematic reviews and case series report improvement in pain and function; evidence sufficient to determine improvement in net health outcome.

Collagen meniscal implant (CMI)

Not established as improving net health outcome

CMI evidence summary: Systematic reviews (primarily case series) report overall positive clinical results with CMI, but study quality is low and radiologic evaluations show frequent implant size reduction, destruction, or absorption; evidence is insufficient to determine that CMI improves net health outcome. Note: CMS issued a 2010 national noncoverage determination for CMI in the Medicare population.

Use of other meniscal implants incorporating materials such as collagen is considered investigational and not established as medically necessary for treatment of meniscal deficiency.

Studies with duplicative or overlapping populations were excluded from the evidence review to avoid counting the same patients multiple times when assessing efficacy and safety.

No additional explicit exclusions are listed in this section of the document regarding candidate selection beyond the policy guidance and contraindications already described.

Meniscal allograft transplantation (MAT) is not recommended for asymptomatic meniscus-deficient patients; candidates should have persistent disabling symptoms despite conservative care. The collagen meniscal implant (CMI) has a Centers for Medicare & Medicaid Services national noncoverage determination (2010), and therefore is not covered for the Medicare population per that decision.

The policy references the CMS decision memo and National Institute for Health and Care Excellence (NICE) guidance concerning partial replacement of the meniscus using biodegradable scaffolds and collagen matrices, and cites these guidance documents when discussing the evidence base and coverage implications.

Prophylactic meniscal transplantation in asymptomatic or minimally symptomatic young athletes is generally not recommended. Additionally, uncorrected malalignment or instability of the knee are contraindications and should be corrected prior to consideration of transplantation.

Evidence on combined MAT and articular cartilage repair is limited and generally of low quality; reported outcomes include symptom reductions and functional improvements but also graft failures and a substantial need for additional surgical procedures in some series.

The document does not explicitly designate CMI as not medically necessary; rather it describes generally low-quality evidence, frequent radiologic evidence of implant degradation or absorption, and some positive clinical outcomes reported in selected studies.

Collagen meniscal implant (CMI) is considered investigational/insufficient to conclude improvement in net health outcome based on available evidence; additionally, CMS concluded in its 2010 decision memo that CMI is not reasonable and necessary for the Medicare population.

At least one study cited in the literature (Kempshall et al.) identified advanced chondral damage as a contraindication to meniscal transplantation; the policy incorporates cartilage status into candidate assessment and requires minimal to absent diffuse degenerative changes for MAT candidacy.

Coding and Diagnostic References

Coding referencemixed

See Codes table

Referenced for details; specific CPT/HCPCS codes not present in this document portion

Regulatory codesmixed

FDA product code OLC

Regulatory product code for collagen meniscus implants

Referenced CPT CodesCPT

29868

Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral

Referenced HCPCS CodesHCPCS

G0428

Collagen meniscus implant procedure for filling meniscal defects (e.g., CMI, collagen scaffold, Menaflex).

Referenced ICD-10-CM Diagnosis CodesICD-10

M23.000-M23.92	Internal derangement of knee code range
S83.200-S83.289	Tear of meniscus, current injury, code range
S83.30-S83.32	Tear of articular cartilage of knee, current, code range

Referenced ICD-10-PCS CodesICD-10

0SQC0ZZ, 0SQC3ZZ, 0SQC4ZZ, 0SQD0ZZ, 0SQD3ZZ, 0SQD4ZZ

ICD-10-PCS surgical codes for lower joints, repair, knee (used for inpatient services); no specific PCS code for this procedure

Meniscal absence threshold — radiologic or prior surgery documentation

Meniscal absence threshold>50% absence of the meniscus established by imaging or prior surgery

Evidence sourcePolicy criteria explicitly requires >50% absence for MAT candidacy

Documentation expectationsCan be established by prior operative report or imaging demonstrating >50% loss

BMI — Obesity level noted as potentially affecting outcomes

Obesity thresholdBody mass index (BMI) >35 kg/m2 may affect outcomes

Provider Responsibilities, Prior Authorization, and Documentation

Prior Authorization

Obtain prior authorization and report procedure codes for MAT

Prior authorization is implied by the Codes section; obtain authorization per the member’s plan procedures and report the applicable procedure codes when requesting approval for meniscal allograft transplantation (MAT).

Include procedure codes listed in the policy’s Codes table when submitting authorizations.

Prior Authorization

Seek prior authorization when planning MAT or meniscal implant with partial meniscectomy

When MAT or a meniscal implant (e.g., collagen scaffold) is proposed as an alternative to or in addition to partial meniscectomy, submit a prior authorization showing the planned use of MAT or implant and the clinical rationale.

State that the intervention is being considered as an alternative to partial meniscectomy and provide supporting clinical documentation.

Definitions and Device Descriptions

Meniscal allograft transplantation (MAT) — definition and context

DefinitionSurgical transplantation of donor meniscal tissue to replace a deficient meniscus (meniscal allograft transplantation, MAT), used as a salvage procedure for symptomatic patients after meniscectomy or near-total meniscectomy

Intended populationTypically reserved for younger patients too young for total knee arthroplasty or those with total/near-total meniscectomy

PurposeAimed to improve symptoms and function in a meniscus-deficient compartment and potentially slow degeneration

Collagen meniscus implant (CMI) — definition as a resorbable collagen matrix scaffold

DefinitionA collagen meniscus implant (CMI) is a resorbable collagen matrix (primarily type I bovine collagen) trimmed and sutured to the remaining meniscal rim to fill defects after partial meniscectomy

Background and Evidence Context

Meniscal cartilage contributes to load distribution, joint stability, proprioception, and cartilage nutrition; partial or total meniscectomy commonly leads to increased contact stresses and progressive degenerative change. MAT and other restorative approaches (including implants) are intended to restore meniscal function, relieve symptoms, and potentially slow joint degeneration in appropriately selected, symptomatic, meniscus-deficient patients.

Evidence considerations expanded

Evidence considerations expanded — systematic reviews, case series, RCTs referenced (use chunks for source details)

Systematic reviews: Harris et al (2011) and other systematic reviews summarized case series of MAT plus cartilage repair with overall improvements but noted limitations of low-quality evidence and frequent additional surgeries (nearly 50%).

See cited systematic reviews and tables in the policy.

Case series and cohort data: Subsequent case series (eg, Stone et al, Kempshall, Ogura, Zaffagnini) report mean allograft survival around 9-10 years in some cohorts, variable revision rates, and mixed outcomes depending on cartilage damage severity.mean survival ~9-10 years

Policy Revision History

2026-04-30policy_revisionLatest

Policy MP 7.01.15 updated (effective and last reviewed 2026-04-30) — current coverage statements for meniscal allograft transplantation (MAT) and position on collagen meniscal implant (CMI) reflected in document.

2010coverage_determination

Centers for Medicare & Medicaid Services issued a national noncoverage determination for collagen meniscus implant (CMI), cited as influencing Medicare coverage considerations.

2012-01-01

Policy Summary

PayerBluecross Idaho

PolicyMeniscal Allografts and Other Meniscal Implants

Policy CodePolicy MP 7.01.15

Change TypeNo material change

Effective DateApr 30, 2026

Last ReviewApr 30, 2026

Next Review DateApr 30, 2026

SourceLink

On This Page

Complications and technical considerations: Reported complications include implant destruction or absorption, inadequate fixation or suture cut-through, avulsion blocking the joint, infection, and allergic reaction.

Ensure appropriate patient selection and surgical technique are documented

Clinical implication

Severe obesity can increase stress on weight-bearing joint surfaces and may be a denial risk if not addressed

Policy guidanceConsider BMI when selecting candidates for MAT and document impact on expected outcomes

Prior Authorization

Specify CMI placement details on prior authorization

If placing a collagen meniscal implant (CMI) during partial meniscectomy, prior authorization should explicitly state that a CMI will be sutured to the meniscal rim and describe the surgical approach and intended use as an alternative to meniscectomy alone.

Describe how the CMI will be secured to the meniscal rim and the clinical rationale for implant use in the operative plan.

Prior Authorization

Expect Medicare noncoverage for collagen meniscus implant (CMI)

Note that the Centers for Medicare & Medicaid Services issued a 2010 national noncoverage determination for the collagen meniscus implant; providers should expect Medicare noncoverage for CMI when requesting authorization or billing.

Disclose Medicare NCD status (2010) on prior authorization submissions for CMI-related procedures.

Billing Rule

Use listed CPT/HCPCS codes for reference; verify member coverage

Use the policy’s listed codes (example CPT 29868; HCPCS G0428) as reference when submitting authorizations or claims, but confirm member-specific coverage and benefits before assuming reimbursement. Inclusion of a code in the policy does not guarantee coverage.

CPT 29868 is listed for meniscal transplantation; HCPCS G0428 is listed for collagen meniscus implant.
Verify member benefit plan documentation prior to billing.

Step Therapy

Confirm and document failed conservative therapy prior to MAT

Document that conservative therapy (e.g., physical therapy and analgesic medications) was tried and failed before MAT is performed; the policy requires refractory symptoms despite conservative treatment.

Include records of physical therapy and analgesic treatment attempts and duration in the prior authorization and medical record.

Note

Document why MAT/CMI is preferred over nonoperative care or meniscectomy alone

Consider nonoperative care or partial meniscectomy alone as a comparator and document why MAT or CMI is clinically indicated instead of these alternatives when submitting authorization requests. Partial meniscectomy without implant is the standard comparator.

Explain why nonoperative care or meniscectomy alone is insufficient for this patient.
Reference that partial meniscectomy without MAT is the comparator of interest.

Note

Acknowledge partial meniscectomy without implant as the comparator

When justifying MAT/implant use, acknowledge that partial meniscectomy without an implant is the standard comparator considered in decision-making and document how the proposed therapy differs from or improves on that standard.

Provide comparative rationale referencing partial meniscectomy without implant as the standard comparator.

Documentation Required

Include prior meniscectomy, imaging confirmation of >50% meniscal loss, and related clinical details

Provide documentation demonstrating prior meniscectomy and a symptomatic meniscus-deficient compartment, with imaging or prior operative reports confirming >50% meniscal absence, refractory disabling activity-related pain, and correction of alignment/instability if present. Also document minimal diffuse cartilage degeneration (e.g., Outerbridge II or less or <50% joint-space narrowing) and that the patient is typically too young for total knee arthroplasty.

Include imaging reports or prior surgical notes showing >50% meniscal loss.
Document trial and failure of conservative therapy, cartilage status, age, and any concurrent corrective procedures.

Documentation Required

Record pain and functional outcomes with timing of assessments

Document outcomes of interest in the medical record and authorization materials, including pain assessments and functional measures, and record timing of outcome assessments (1–10 years).

Include pain scales and functional outcome documentation with specified follow-up timing.
Report any objective range-of-motion or activity measures relevant to knee function.

Documentation Required

Document indication that CMI was used with partial meniscectomy and include surgical rationale

For CMI cases, document that the implant was used as part of a partial meniscectomy and include the surgical rationale and evidence basis; note that studies used specific methodological selection criteria (preference for RCTs and prospective comparative studies).

State clearly in operative notes that the CMI was sutured to the rim and why an implant was chosen versus meniscectomy alone.
Reference the types of studies considered when describing the evidence basis, if requested.

Documentation Required

Include standardized outcome scores (WOMET, KOOS, Marx) in follow-up documentation

Include validated outcome measures in documentation when available, such as Western Ontario Meniscal Evaluation Tool (WOMET), Knee injury and Osteoarthritis Outcome Score (KOOS), and the Marx Activity Rating Scale, to support assessment of treatment effect.

WOMET, KOOS, Marx Activity Rating Scale, and EuroQol 5D are suggested instruments to document outcomes.

Billing Rule

Verify member-specific coverage despite listed coding guidance

Use the policy’s coding guidance for reference, but determine coverage using the member-specific benefit plan and the written coverage position in this medical policy; inclusion of codes in the document is informational only.

Do not assume inclusion in the Codes table guarantees payment—confirm with member benefits.

Denial Risk

Document correction of malalignment/instability and note BMI-related risks

Address contraindications and risk factors in the record: correct malalignment and instability before or during MAT; recognize severe obesity (BMI >35 kg/m2) may adversely affect outcomes and could be a denial risk if not addressed.

Document any corrective procedures or rationale if malalignment/instability are present.
Record BMI and discuss weight-management plans if BMI >35 kg/m2 is present.

Note

Avoid relying on duplicative or overlapping studies when supporting evidence

Exclude studies with duplicative or overlapping populations from evidence summaries when presenting research justification, per the policy’s study selection criteria.

If submitting literature, ensure included studies are methodologically distinct and not overlapping populations per the policy.

Denial Risk

Document technique and selection to address known CMI complications

Be aware that reported procedural complications (implant destruction, inadequate fixation, infection, allergic reaction, avulsion) have been observed with CMI; document appropriate patient selection and surgical technique to mitigate denial risk related to complications.

Describe steps taken to ensure adequate vascularity, fixation technique, and postoperative protection to reduce risk of implant destruction or avulsion.

Denial Risk

Medicare national noncoverage (2010) for CMI — expect denials for Medicare

CMS issued a 2010 national noncoverage determination concluding that collagen meniscus implant is not reasonable and necessary for Medicare beneficiaries; expect Medicare denials for CMI and document alternative plans when treating Medicare patients.

Indicate on submissions for Medicare members that CMI has an NCD and discuss alternative treatment options.

Billing Rule

Confirm member benefit coverage before billing—codes do not guarantee reimbursement

Inclusion of a code in the policy’s Codes table does not guarantee member coverage or reimbursement; confirm member-specific benefit plan documentation before billing or relying on listed codes.

Verify benefits and preauthorization requirements for each member prior to scheduling or billing.

Designed to act as an absorbable scaffold to be replaced by the patient’s soft tissue; requires a meniscal rim for attachment

Example productsCMI (Menaflex/ReGen) and RejuvaKnee described with similar characteristics

Meniscal Allograft Transplantation (MAT) — alternate definition entry

Alternate definitionTransplantation of donor meniscal tissue intended to improve symptoms and reduce joint degeneration in individuals who have had total or partial meniscus resection

Clinical goalImprove pain, function, and joint stability in a meniscus-deficient compartment

Evidence contextSupported by systematic reviews, case series, and limited RCT data showing symptom and function improvements in selected patients

Collagen Meniscal Implants (CMI) — alternate definition entry

Alternate definitionCollagen meniscal implants are collagen-based scaffolds intended as an alternative or adjunct to partial meniscectomy, sutured into place on the meniscal rim

Procedure contextIntended to be used during a partial meniscectomy to fill meniscal defects rather than replace the entire meniscus

RequirementRequires sufficient meniscal rim for fixation and suturing

Collagen meniscal implant (CMI) — scaffold description and intended use

Scaffold compositionPrimarily type I bovine collagen (from Achilles tendon or meniscus depending on product)

Intended mechanismProvides an absorbable collagen scaffold trimmed to size and sutured to the meniscal rim to be replaced by host tissue over time

Use-caseDesigned to fill defects after partial meniscectomy when a meniscal rim remains for attachment

Meniscal Allograft Transplantation (MAT) — evidence summary cross-reference

Evidence summarySystematic reviews and case series (and 1 small RCT) report statistically significant improvements in pain and function after MAT, with some long-term benefits (>10 years)

LimitationsEvidence primarily consists of case series and observational studies; single small RCTs limit strength of conclusions

Clinical implicationEvidence considered sufficient to determine an improvement in net health outcome for selected patients when MAT criteria are met

Collagen Meniscal Implant (CMI) — biodegradable scaffold and evidence quality note

Definition and compositionA biodegradable collagen scaffold implanted to partially replace the meniscus after partial meniscectomy

Evidence qualitySystematic reviews report overall positive clinical results but the quality of studies is low (primarily case series and small RCTs)

Durability concernsRadiologic evaluations frequently show implant size reduction, destruction, or absorption in a large portion of patients

Collagen meniscus implant (CMI) — example procedure and HCPCS code reference (Menaflex/CMI)

Example device and codeMenaflex/CMI (collagen scaffold) referenced; HCPCS code G0428 is listed for collagen meniscus implant procedures

Procedure descriptionCMI is trimmed and sutured to the meniscal rim during partial meniscectomy to fill defects

Coding noteInclusion of HCPCS G0428 is for reference; coverage is subject to member-specific plan and Medicare noncoverage policies

From case series summaries in policy

Randomized trials: A single small randomized controlled trial is included in the evidence base but pooled with nonrandomized data in analyses; its results are difficult to interpret and limit confidence in comparative conclusions.

Policy notes limited RCT data

Outcome heterogeneity and reoperations: Studies report improvements from baseline but heterogeneity in outcomes and a high proportion of patients requiring additional surgeries or revisions in some series (eg, up to 47%).

Documented in systematic reviews and case series

policy_history_entry

Policy history includes prior updates beginning in 2012 through 2026 as recorded in the document revision history.

Policy revision history entries are documented for 2012 through 2026 with iterative literature reviews and periodic updates; the most recent entry reflects an update effective 04/30/2026 with references reviewed through February 25, 2026.