Medicare AdvantageCoverageMedium impact
Allograft Transplantation of the Knee - Medicare Advantage (Revised)
Humana·Orthopedics, Sports Medicine·Medicare Advantage
Effective date
Aug 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their policy for allograft knee transplantation procedures, establishing specific medical necessity criteria for meniscal allograft transplantation including age limits (≤50 years), BMI requirements (≤40), and mandatory conservative treatment failure documentation. The policy covers ligament reconstruction with allografts and sets clear coverage limitations for certain implant types.
Action Required
Before August 1, 2025: Billing team must update prior authorization requirements for meniscal allograft transplantation procedures to include documentation of patient age ≤50 years, BMI ≤40, MRI showing meniscus absence, Outerbridge grade II or less articular changes, and 6-12 weeks of failed conservative treatment. Update encounter forms to remind providers of these documentation requirements for CPT codes 27427 and 27428 when used for knee procedures.