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 MyCartilageCare 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.
typical ICD-10 codes
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
examples of cpt codes at time of biopsy
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
ACI CPT Code
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
HCPCS Codes
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.