Collagen Meniscus Implants Non-covered

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  • June 11, 2010
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Effective for dates on or after May 25, claims submitted for a collagen meniscus implant procedure will be denied by Medicare. The Centers for Medicare & Medicaid Services (CMS) completed a National Coverage Determination (NCD) for collagen meniscus implants in May, rendering the procedure non-covered for Medicare beneficiaries.
Effective with the July 2010 updates of the Medicare Physician Fee Schedule Database (MPFSDB) and the Integrated Outpatient Code Editor (I/OCE), new HCPCS Level II code G0428 Collagen or other tissue engineered meniscus knee implant procedure for filling meniscal defects (e.g., collagen scaffold, Menaflex) should be used to report non-covered collagen meniscus implant claims with service dates on and after May 25.
As is custom, notifying the Medicare patient of his or her responsibility to pay for this non-covered service and asking the patient to sign an Advanced Beneficiary Notice (ABN) would be appropriate.
NOTE:  This NCD does not include cadaver meniscus transplants, for which you would report CPT® code 29868 Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral.
Source: CMS Transmittal 1977, CR 6903, issued May 28.

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