Helpful Codes For Allograft Meniscus Reconstruction

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice. The information was compiled from various resources and is subject to change.

Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services rendered. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies as payment for medical products and services is affected by numerous factors.
Ranges below indicate several options are available for the same procedure (e.g. left, right or bilateral)

Typical Medical Policy Guidelines for Meniscus Allograft Reconstruction

Many health plans consider meniscus allograft transplantation of the knee a medically necessary treatment when specific criteria are met. The list below includes many of the criteria considered by health plans. Providers should consult the patient’s third-party payer’s Medical Policy for a complete list.

• Skeletally mature up to and including age 55 years; and
• Disabling knee pain refractory to conservative treatment; and
• Ligamentous stability prior to surgery or achieved concurrently with meniscus transplantation; and
• Documented mild to moderate articular damage (Outerbridge grade II or less); and
• BMI ≤ 35; and
• Normal alignment without varus or valgus deformities; and
• Missing 50% or more of meniscus; and
• Absence of meniscus firmly established by previous operative reports, magnetic resonance imaging (MRI), or diagnostic arthroscopy.

Typical ICD-10 Codes

• M23.200-M23.269 – Derangement of meniscus due to old tear or injury, knee
• M23.300-M23.369 – Other meniscus derangements, knee
• Q68.6 – Discoid meniscus
• S83.200+ - Tear of unspecified meniscus, current injury
• S83.211+-S83.249 – Tear of medial meniscus, current injury
• S83.251+-S83.289+ - Tear of lateral meniscus, current injury
• S83.30X+-S83.32X+ - Tear of articular cartilage, knee

Typical ICD-10 Procedure Code

• 0SUC0KZ-0SUC4KZ – Supplement right knee joint with nonautologous tissue substitute
• 0SUD0KZ-0SUD4KZ – Supplement left knee with nonautologous tissue substitute

CPT Code

• 29868 – Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral

Typical HCPCS Codes

• C1762 – Billing code for allograft

Typical Revenue Codes (for form UB-04)

• 278 – Other implants

CPT Modifiers

Physicians may bill modifiers to indicate that a procedure performed has been altered by some specific circumstances, but not changed in its definition or code.

• 22 – Indicates an unusual procedure where additional reimbursement may be made if the payer agrees the procedure involved exceptional circumstances. This modifier will trigger manual review of the claim.
• 50 – Bilateral
• RT – Right
• LT – Left

Updated on: 18/03/2021