Medicare AdvantageCoverageMedium impact
Osteochondral and Subchondral Defects Surgery - Medicare Advantage (Revised)
Humana·Orthopedics, Sports Medicine·Medicare Advantage
We identified it
Jul 2, 2026
Summary
Medicare Advantage has issued a revised policy on osteochondral and subchondral defect surgery, defining these conditions as damage to articular cartilage and underlying bone from trauma or degeneration (OCD, osteoarthritis, osteonecrosis). The policy establishes that surgical procedures are available to stimulate cartilage growth. Billing teams must verify coverage criteria and any prior authorization requirements for affected orthopedic procedures under this revised guidance.
Action Required
Immediately: Billing team must obtain and review the complete policy document from the provided Humana URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5699ab) to identify specific CPT codes, prior authorization requirements, and medical necessity criteria. Update internal policy documentation and communicate any coverage changes to orthopedic providers. Verify whether this revision supersedes previous Humana guidance on osteochondral repair procedures. Do not bill claims for osteochondral or subchondral defect surgery until the complete policy details are reviewed and integrated into billing workflows.