Autologous Chondrocyte Implantation (ACI) - (Effective Date - 2026-10-15) 7.01.38
Summary
Excellus BlueCross BlueShield medical policy 7.01.38 on autologous chondrocyte implantation (ACI), using the matrix-induced ACI (MACI) implant, has a current effective date of October 15, 2026. ACI is considered medically appropriate for individuals aged 15 to 55 with a BMI of 35 or less, no inflammatory arthritis, Kellgren-Lawrence Grade II or less on radiographs, and a full-thickness distal femoral or patellar chondral defect of 1 to 10 cm2 identified by CT arthrogram, by MRI with Modified Outerbridge Grade III or IV, or by arthroscopy with Outerbridge Grade III or IV. The policy also requires function-limiting knee pain and at least three months of failed provider-directed, non-surgical management, and it considers ACI not medically necessary for several other indications, including any knee joint surgery within six months before screening and cruciate ligament instability. Hybrid ACI performed with osteochondral autograft transfer is considered investigational for osteochondral defects.
Get alerts when payers change rules like this one
We check Excellus BlueCross BlueShield and other payers every day and email you when a change matches your specialty and state.