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Allograft transplant for orthopedic procedures of the knee (e.g., DeNovo®NT)

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

Prior authorization is required for allograft used for knee replacement.

Coverage

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Allograft used for knee replacement is considered investigational/experimental and is therefore not covered.

Definitions

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Allograft refers to the transplant of tissue or an organ from one individual to another. DeNovo®NT Natural tissue graft is an example of an allograft used to repair the knee.

Codes

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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.

The following code is not covered when used to report juvenile cartilage allograft tissue implantation:

27599 - Unlisted procedure, femur or knee

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

References

  1. Hayes Search & Summary. “DeNovo® NT Natural Tissue Graft (Zimmer Inc.) for Articular Cartilage Repair,” 3/29/12, archived 2013.
  2. ECRI Hotline. “DeNovo NT Natural Tissue Graft (Zimmer, Inc.) for repairing cartilage.” 8/5/13
  3. Hussain, et al. “Strategies in articular cartilage restoration – Present advances in biologic intervention for adult knee problems.” Semin Arthro 23:2-6 – 2012
  4. Tompkins et al. “DeNovo NT Allograft.” Oper Tech Sports Med 2013 - 21:82-89

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.