29868 Insurance Policy Changes

Autologous Chondrocyte Implantation (CPB 0247, reviewed 2026-04-16)

Aetna has updated its Clinical Policy Bulletin 0247 for Autologous Chondrocyte Implantation (ACI), establishing detailed medical necessity criteria for knee cartilage repair procedures. The policy covers CPT 27412 and HCPCS J7330/S2112 when strict patient and defect criteria are met, while explicitly designating numerous combination procedures and alternative joint treatments as experimental/non-covered. Billing teams must verify all 13 medical necessity requirements before submitting claims to avoid denials.