Intended for U.S. health care professionals only
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:
Insurance
support
Copay
program
Treatment
education
Biopsy
storage
Patient insurance approval
MyCartilageCare can provide patient benefit investigation, predetermination & prior authorization, and reimbursement support.
Assist CoPay Program
MyCartilageCare Assist CoPay Program is a copay assistance program for eligible adult patients who are undergoing surgery with MACI (autologous cultured chondrocytes on porcine collagen membrane) to repair their knee cartilage damage.*
Review Full Terms and Conditions
*The MCC Assist CoPay Program is only valid in the U.S. for eligible patients 18 years or older with commercial/private insurance. The program is not valid for patients enrolled in or covered under any government healthcare insurance programs or where the entire cost of the implant is reimbursed by a plan. The program provides assistance with the out-of-pocket costs for the MACI implant only. The program does not cover the costs of any other healthcare provider charges, including procedure charges, office visit fees, or any other product or treatment related costs. Use of implant must be for an FDA-approved indication. The Program is not valid where prohibited by law, taxed, or otherwise restricted. The program expires December 31, 2024. Additional terms and conditions, eligibility requirements, and restrictions apply. See mycartilagecare.com/assist.
MACI insurance approval success rates†
89% of all MACI cases were approved on initial submission
7% Not appealed
3% Approved on appeal
1% Denied after appeal
MACI insurance approval specific to patella cases
- 88% Approved on initial submission
- 8% Approved on appeal
- 4% Not appealed
- 0% Denied after appeal
†MACI cases activated between January 2023 and December 2023. Data on file. Insurance approval is defined as payor pre-authorization for the MACI procedure. Coverage, coding, and payment information is provided for informational purposes only and is subject to change. 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. Providers should exercise independent clinical judgment when selecting codes and submitting claims to reflect accurately the services rendered to individual patients.
Billing Codes
CPT Code (Open): 27412
Autologous chondrocyte implantations, knee
CPT Code (Arthro): 29999
Unlisted procedure, arthroscopy
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.
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: