MyCartilageCare, a support program for MACI Skip to content

Intended for U.S. health care professionals only

MyCartilageCare logo

Dedicated Support Tailored to Your Patients

A dedicated MyCartilageCare Case Manager is committed to offering comprehensive support tailored to your patient’s individual insurance requirements and treatment goals. Call 1-877-872-4643 or email [email protected].

MyCartilageCare offers support including:

Support icon

Insurance
support

Phone icon

Treatment
education

Biopsy icon

Biopsy
storage

#

Patient insurance approval

MyCartilageCare can provide patient benefit investigation, predetermination & prior authorization, and reimbursement support.

MACI insurance approval success rates*

Insurance approval chart

89% of all MACI cases were approved on initial submission

5% Not appealed

5% Approved on appeal

1% Denied after appeal

#

MACI insurance approval specific to patella cases

  • 89% Approved on initial submission
  • 5% Approved on appeal
  • 5% Not appealed
  • 1% Denied after appeal

MACI cases activated between January 2021 and December 2021. Data on file. Insurance approval is defined as payor pre-authorization for the MACI procedure. Nothing contained herein is intended, nor should it be construed, to suggest a guarantee of coverage or reimbursement for any product or service. Check with the individual insurance provider regarding coverage.

#

Access HCP resources and downloads at www.MyCartilageCare.com/approval

#

Billing Codes

CPT Code:
27412

Autologous chondrocyte implantations, knee

HCPCS Code:
J7330

Autologous cultured chondrocytes, implant

Biopsy HCPCS Code:
S2112

Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells)

Item 21 or Form Locator (FL) 67—Diagnosis Code: The appropriate ICD-10-CM code(s) should be entered for the MACI implant in Item 21 of the CMS-1500 form for physician offices or FL 67 of the CMS-1450 (UB-04) claim form for the hospital outpatient department.

The content presented is for informational purposes only and is not a guarantee of coverage. Providers should exercise independent clinical judgment when selecting codes and submitting claims to reflect accurately the services rendered to individual patients. Providers are responsible for selecting coding options that most accurately reflect a patient’s condition, the provider’s system guidelines, payer requirements and services rendered.

Important notes for physician offices: Reimbursement will depend upon the contract with the insurer. The physician may want to consult with the insurer’s contracting representative to determine how the contract may affect reimbursement.

Upcoming events

November 29, 2022

MASTERs—MACI Advanced Surgeon Training

Virtual | 8:00-9:30pm ET

December 12-16

Society of Military Orthopaedic Surgeons (SOMOS)

Scottsdale, AZ

January 22–25, 2023

23rd Annual AAOS/AOSSM/AANA Sports Medicine Course

Park City, UT

MACI surgeon training

Ready to introduce MACI to your patients with knee cartilage injuries? Complete surgeon training at:

#

MACI physical therapist training

Ready to become a MACI cartilage repair physical therapy expert? Expand your rehab expertise by completing MACI PT training at:

Indication and Important Safety Information

Important Safety Information

MACI is contraindicated in patients with a known history of hypersensitivity to gentamicin, other aminoglycosides, or products of porcine or bovine origin. MACI is also contraindicated for patients with severe osteoarthritis of the knee, inflammatory arthritis, inflammatory joint disease, or uncorrected congenital blood coagulation disorders. MACI is also not indicated for use in patients who have undergone prior knee surgery in the past 6 months, excluding surgery to procure a biopsy or a concomitant procedure to prepare the knee for a MACI implant.

MACI is contraindicated in patients who are unable to follow a physician-prescribed post-surgical rehabilitation program.

The safety of MACI in patients with malignancy in the area of cartilage biopsy or implant is unknown. Expansion of present malignant or dysplastic cells during the culturing process or implantation is possible.

Patients undergoing procedures associated with MACI are not routinely tested for transmissible infectious diseases. A cartilage biopsy and MACI implant may carry the risk of transmitting infectious diseases to healthcare providers handling the tissue. Universal precautions should be employed when handling the biopsy samples and the MACI product.

Final sterility test results are not available at the time of shipping. In the case of positive sterility results, health care provider(s) will be contacted.

To create a favorable environment for healing, concomitant pathologies that include meniscal pathology, cruciate ligament instability and joint misalignment, must be addressed prior to or concurrent with the implantation of MACI.

Local treatment guidelines regarding the use of thromboprophylaxis and antibiotic prophylaxis around orthopaedic surgery should be followed. Use in patients with local inflammations or active infections in the bone, joint, and surrounding soft tissue should be temporarily deferred until documented recovery.

The MACI implant is not recommended during pregnancy. For implantations post-pregnancy, the safety of breast feeding to infant has not been determined.

Use of MACI in pediatric patients (younger than 18 years of age) or patients over 65 years of age has not been established.

The most frequently occurring adverse reactions reported for MACI (≥5%) were arthralgia, tendonitis, back pain, joint swelling, and joint effusion.

Serious adverse reactions reported for MACI were arthralgia, cartilage injury, meniscus injury, treatment failure, and osteoarthritis.

Please see Full Prescribing Information for more information.

Indication

MACI® is an autologous cellularized scaffold product that is indicated for the repair of single or multiple symptomatic, full-thickness cartilage defects of the adult knee, with or without bone involvement.

MACI® (autologous cultured chondrocytes on porcine collagen membrane) is an autologous cellularized scaffold product that is indicated for the repair of single or multiple symptomatic, full-thickness cartilage defects of the adult knee, with or without bone involvement.

MACI is intended for autologous use and must only be administered to the patient for whom it was manufactured. The implantation of MACI is to be performed via an arthrotomy to the knee joint under sterile conditions.

The amount of MACI administered is dependent upon the size (surface in cm2) of the cartilage defect. The implantation membrane is trimmed by the treating surgeon to the size and shape of the defect, to ensure the damaged area is completely covered, and implanted cell-side down.

Limitations of Use

Effectiveness of MACI in joints other than the knee has not been established.

Safety and effectiveness of MACI in patients over the age of 55 years have not been established.