billing codes

The majority of plans routinely reimburse fully for this treatment option using HCPCS code J7330 for autologous cultured chondrocytes and CPT code 27412 for autologous chondrocyte implantation

Contact a MyCartilage Care Representative for reimbursement support at: 877-872-4643

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice.

The information has been compiled from various resources and is subject to change. Providers should exercise independent clinical judgment when selecting codes and submitting claims to reflect accurately the services rendered to individual patients.

Third-party payment for medical products and services is affected by numerous factors. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies.

This document is not intended to be a directive, nor is it a suggestion about the likelihood of obtaining reimbursement. This list is not all-inclusive, and physician and staff may deem other codes more appropriate. 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.

Unspecified internal derangement of unspecified knee

M23.90

Joint disorder, unspecified

M25.9

Disorder of cartilage, unspecified

M94.9

Chondromalacia, unspecified site

M94.20

Other tear of medial meniscus, current injury, unspecified knee, initial encounter

S83.249A

Other tear of lateral meniscus, current injury, unspecified knee, initial encounter

S83.289A

Unspecified tear of unspecified meniscus, current injury, unspecified knee, initial encounter

S83.209A

Tear of articular cartilage of unspecified knee, current, initial encounter

S83.30XA

Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)

29870

Arthroscopy, knee, for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation)

29874

Arthroscopy, knee, debridement/shaving of articular cartilage (chondroplasty)

29877

Autologous Chondrocyte Implantation CPT Code

The American Medical Association (AMA) has issued a unique and permanent Category I CPT Code for autologous chondrocyte implantation (ACI), effective January 1, 2005. Please use the below code for MACI implantation. The exact terminology is as follows:

Autologous Chondrocyte Implantation, Knee

27412

Autologous cultured chondrocytes, implant

J7330

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

S2112

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.