CommercialAdministrativeLow impact
11.14.09h, Osteochondral Autograft Transplantation (Independence Administrators)
Independence Blue Cross·Orthopedics, Sports Medicine·Medical Policy
We identified it
Jun 19, 2026
Summary
This policy was reissued on 06/10/2026 with no substantive changes to coverage criteria for Osteochondral Autograft Transplantation (OAT). The policy applies only to Independence Administrators claims and groups that have not enrolled in the UM vendor program. Billing teams should verify member eligibility and confirm whether their patient's group uses this policy or the AIM Specialty Health guidelines for Commercial Independence members.
Action Required
No immediate action required. This is an informational reissue with no changes to medical necessity criteria, covered procedures, or billing codes. Billing team should confirm member eligibility prior to billing OAT procedures: (1) Verify that Independence Administrators serves as the claims administrator for the member's group; (2) Confirm the group has NOT enrolled in the UM vendor program (if enrolled, refer to AIM Specialty Health guidelines instead); (3) For Commercial Independence members, use policy #00.01.66 (Musculoskeletal Services) and AIM guidelines, not this policy. Document all eligibility verification in patient records before service delivery.