MACI Insurance Approval Rates & Billing Codes
Important Safety Information
Full Prescribing Information
Cartilage Repair Blog
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High Insurance Approval Rates and Coding Support to Streamline Access†

90% Pie

96% of all MACI cases were approved by insurance

90% Approved on the first try
6% Approved on appeal
3% Not appealed
1% Denied after appeal
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MACI insurance approval specific to patella cases

  • 90% Approved on initial submission
  • 6% Approved on appeal
  • 3% Not appealed
  • 1% Denied after appeal

†MACI cases activated between January 2025 and December 2025. 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.

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Access HCP resources and downloads at www.MyCartilageCare.com/healthcare-professionals

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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, payor 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.

Indication and Important Safety Information

Important Safety Information

Contraindications: MACI is contraindicated in patients with a known history of hypersensitivity to gentamicin, other aminoglycosides, products of porcine or bovine origin; in patients with severe osteoarthritis of the knee, inflammatory arthritis, inflammatory joint disease, or uncorrected congenital blood coagulation disorders; 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; or in patients unable to cooperate with a physician-prescribed post-surgical rehabilitation program.

Warnings and Precautions:
  • Malignancy: The risk of MACI in patients with malignancy in the area of cartilage biopsy or implant is unknown. Expansion of malignant or dysplastic cells present in biopsy tissue during manufacture and subsequent implantation may be possible.
  • Transmissible infectious diseases: Because patients undergoing procedures associated with MACI are not routinely tested for transmissible infectious diseases, cartilage biopsy and MACI implant may carry risk of transmitting infectious diseases.
  • Presurgical Comorbidities: Local inflammation or active infection in the bone, joint, and surrounding soft tissue, meniscal pathology, cruciate ligament instability, and misalignment should be assessed and treated prior to or concurrent with MACI implantation.
  • Product Sterility: Final sterility test results are not available at the time of shipping.

Adverse Reactions: 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.

Specific Populations:
  • Use of MACI in pediatric patients (younger than 18 years of age) or in patients over 65 years of age has not been established.
  • The MACI implant is not recommended during pregnancy. For implantations post-pregnancy, the safety of breastfeeding to an infant has not been determined.

To report negative side effects, contact Vericel Corporation at 1-800-453-6948 or FDA at 1-800-FDA-1088 (1-800-332-1088) or www.fda.gov/medwatch.

Please see Full Prescribing Information.

Indication

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

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

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.