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Synthetic Cartilage Implants for Joint Pain
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Synthetic cartilage implants are considered investigational for the treatment of articular cartilage damage. The Cartiva synthetic polyvinyl alcohol implant was FDA-approved in 2016 for painful degenerative or posttraumatic arthritis in the first metatarsophalangeal joint, and the policy states that the Federal Employee Program may dictate that FDA-approved devices are not considered investigational and may be assessed only on the basis of medical necessity. The 09/11/2025 review made no changes to the policy statement.
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What to do
Action · 5 steps
01Billing team: the policy lists these codes as investigational, including CPT 28291 (hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint, with implant), CPT 28899 (unlisted procedure, foot or toes), HCPCS L8641 (metatarsal joint implant), L8642 (hallux implant), and L8699 (prosthetic implant, not otherwise specified), and the listed ICD-10-PCS synthetic substitute codes.
02Synthetic cartilage implants are investigational for the treatment of articular cartilage damage, and investigational services are not considered medically necessary.
03Federal Employee Program members may be assessed on medical necessity only, as the policy describes.
04The Cartiva implant contraindications are lesions greater than 10 mm in size and insufficient quality or quantity of bone, so document lesion size and bone quality and quantity in the chart.
05Check current applicability at the source link, because the most recent review listed is dated 09/11/2025.
Codes mentioned
2829128899L8641L8642L8699
Original notice
Synthetic Cartilage Implants for Joint Pain
bcbsms.com · Always check the source before changing claims.
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