M23.000 Insurance Policy Changes

ICD-10 M23.000 is officially defined as "Cystic meniscus, unspecified lateral meniscus, right knee." code M23.000 is referenced in 4 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code M23.000 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 16, 2026Medium impact
Knee Arthroscopy / Osteoarthritis of the Knee (CPB 0673, reviewed 2026-02-19)
Aetna's clinical policy bulletin on knee arthroscopy and knee osteoarthritis considers arthroscopic knee surgery, partial meniscectomy, and meniscal repair medically necessary only when the member has significant symptoms, no more than mild osteoarthritis (Kellgren-Lawrence 0, 1, or 2, or modified Outerbridge 0, 1, or 2), radiologic confirmation of the pathology, and failed conservative therapy. Chondroplasty (29877) is integral to other arthroscopic knee procedures and cannot be approved as an isolated request for significant arthritis. Zilretta is considered not medically necessary, and arthroscopic lavage or debridement for knee pain only or severe osteoarthritis, radiofrequency ablation, subchondroplasty and other listed treatments for knee osteoarthritis are considered experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Electrothermal Arthroscopy (CPB 0545, reviewed 2026-07-31)
Aetna considers electrothermal arthroscopy, also called electrothermally-assisted capsule shift or capsulorrhaphy (ETAC), of the joint capsule, ligaments, or tendons experimental, investigational, or unproven for all indications. The listed indications include shoulder instability, Bankart lesions, frozen shoulder, ligament tears and meniscal injury of the knee, partial scapholunate ligament tears, temporomandibular joint dislocation, and wrist injuries. HCPCS S2300 (arthroscopy, shoulder, with thermally-induced capsulorrhaphy) is listed as not covered for the indications in the policy.
Aetna · Identified Aug 13, 2026Medium impact
Osteochondral Autografts (Mosaicplasty, OATS) (CPB 0637, reviewed 2026-01-16)
Aetna considers osteochondral autografts (OATS or mosaicplasty) medically necessary for symptomatic focal full-thickness articular cartilage defects of the knee when all listed criteria are met. The criteria include skeletal maturity with documented closure of growth plates, age under 55, grade III or IV lesions of 2 to 4 sq cm for arthroscopic cases or 2 to 8 sq cm for open cases, BMI less than or equal to 35, and nicotine-free status for at least 6 weeks before surgery. Agili-C, autologous cartilage chip transplantation, hybrid ACI/OATS, osteochondral autografts of joints other than the knee, and synthetic resorbable polymers such as PolyGraft, TruFit and TruGraft are considered experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Meniscal Allografts and Other Meniscal Implants
This Blue Cross Blue Shield policy states that meniscal allograft transplantation may be considered medically necessary in individuals who have had a prior meniscectomy and have symptoms on the affected side, when all listed criteria are met. The criteria include disabling knee pain refractory to conservative treatment, absence or near absence (more than 50%) of the meniscus, minimal to absent diffuse degenerative changes, and normal knee biomechanics or alignment and stability achieved concurrently with the transplant. Other meniscal implants incorporating materials such as collagen are considered investigational. The 03/26/2026 policy update removed the ICD-9 procedure and diagnosis codes.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code M23.000?

There are 4 tracked policy changes affecting code M23.000, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code M23.000?

Payers that have issued tracked updates for code M23.000 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code M23.000 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code M23.000. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code M23.000?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Knee Arthroscopy / Osteoarthritis of the Knee (CPB 0673, reviewed 2026-02-19)

Electrothermal Arthroscopy (CPB 0545, reviewed 2026-07-31)

Osteochondral Autografts (Mosaicplasty, OATS) (CPB 0637, reviewed 2026-01-16)

Meniscal Allografts and Other Meniscal Implants

What insurance policy changes affect code M23.000?

Which payers have updated policy for code M23.000?

How do I get notified when code M23.000 policy changes?

Why do payers change policies for code M23.000?