CommercialAdministrativeLow impact
11.14.03h, Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators)
Independence Blue Cross·Orthopedics, Sports Medicine·Medical Policy
We identified it
Jun 19, 2026
Summary
This is a reissue with no changes to policy 11.14.03h regarding meniscal allograft transplantation and meniscal implants for Independence Administrators. The policy continues to cover meniscal allograft transplantation when specific medical necessity criteria are met, including patient age (15+ or ≤55 years), prior total/near-total meniscectomy, failed conservative treatment, and minimal cartilage degeneration (Outerbridge grade II or less). Collagen meniscus implants (CMI/Menaflex) remain experimental/investigational and not covered.
Action Required
No immediate action required. This is a routine reissue with no substantive policy changes. Billing team should verify that current billing software and prior authorization workflows continue to reflect: (1) CPT 29868 requires prior authorization with documentation of medical necessity criteria before submission; (2) G0428 (collagen meniscus implant) is denied as experimental/investigational; (3) Independence Administrators claims only—do not apply this policy to Commercial Independence members (they use AIM Specialty Health guidelines per policy #00.01.66). Maintain current documentation requirements in patient charts before service delivery.