CommercialCoverageMedium impact
Implantable Shock Absorbers for Treatment of Knee Osteoarthritis
Blue Cross & Blue Shield of Mississippi·MS · Orthopedics, Sports Medicine, Pain Management +1 more·Medical Policy
Effective date
Aug 15, 2026
We identified it
Aug 22, 2026
Summary
New policy establishes that implantable shock absorbers for knee osteoarthritis treatment (specifically the MISHA Knee System) are classified as investigational and not covered. Despite FDA approval in April 2023, this payer considers the technology investigational until it meets specific criteria for general acceptance in medical practice. Billing teams must deny claims for CPT C1734 when billed for this indication and ensure prior authorization processes reflect investigational status.
Action Required
By August 15, 2026: Billing team must update billing system to classify CPT C1734 (implantable shock absorber for knee OA) as investigational for all patient encounters. Add to prior authorization requirements that all claims for this code with knee OA diagnosis must be denied as investigational unless member has FEP coverage (Federal Employee Program may override investigational determination). Update claim denial templates to cite Policy A.7.01.90 and specify that device is not yet considered standard medical practice despite FDA approval. Flag any FEP member claims for manual review to assess medical necessity separately. Providers should be notified via bulletin that prior authorization will not be granted for this procedure outside of FEP plans. Monitor for policy updates as clinical evidence accumulates, as policy allows for future reconsideration when technology meets criteria for general acceptance in medical practice.