Autologous chondrocyte implantation (ACI)

These services may or may not be covered by all CoOportunity Health plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative process

Autologous chondrocyte implantation does not require prior authorization.

Autologous chondrocyte implantation (ACI) is covered as per the indications listed below.

Indications that are covered

1. The patient meets the inclusion criteria as follows:
   1. An isolated focal articular cartilage defect (grade III or IV chondromalacia) localized to the femoral condyles
   2. No evidence of arthritis on the articular surface of the corresponding tibia
   3. No evidence of malalignment (genu varus or valgus)
   4. Normal ligamentous stability (no evidence of MCL, ACL, PCL, or posterolateral corner injuries and resulting instability)
   5. Appropriate inclusion ages (15 to 45)
   6. Demonstration of ability to comply with protocol by patient (non-weight bearing for eight weeks, use of CPM machine for 8 weeks, ability to cooperate during the 8 to 16 week period where a formal exercise program is necessary)

Autologous chondrocyte implantation (ACI) is a procedure which uses a person's own cartilage cells to repair a defect or tear to the articular cartilage of the knee. The cartilage cells are removed from the body, grown in the manufacturer's lab, and implanted into the affected knee. The goal is that the implanted cartilage will be similar to the knee's normal hyaline cartilage, which has the durability to withstand the wear and tear of the knee movement.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

27412 - Autologous chondrocyte implantation, knee
J7330 - Autologous cultured chondrocytes, implant
S2112 - Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells)

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Bibliography

Bibliography available on request.

This information is for most, but not all, CoOportunity Health plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.