Meniscal Allograft Transplant*

Medical Policy: 07.01.16 
Original Effective Date: September 2001 
Reviewed: June 2008 
Revised: May 2007 

This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's coverage manual for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply.

Description: 

Meniscal allograft transplantation is a surgical procedure for the treatment of patients with irreparable meniscus tears or who have undergone a complete or near-complete meniscectomy. The procedure involves the grafting of donor meniscus into the knee and can be accomplished arthroscopically or by open technique. The goal of the procedure is restoration of knee function and prevention of further degeneration. Other reconstructive procedures, such as anterior cruciate ligament (ACL) repair may be performed concomitantly.

Policy: 

Meniscal allograft transplant may be considered medically necessary in patients meeting all of the following criteria:

  • Physically active and under age 55
  • Missing more than half of the meniscus due to surgery or injury or has a tear that cannot be repaired
  • Continues to have activity-related pain in the knee
  • Has little or no evidence of arthritis in the knee

All other indications for meniscal allograft transplant are considered investigational.

Prior approval is recommended. Submit a prior approval now.


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Procedure Codes and Billing Guidelines: 

  • To report provider services, use appropriate CPT** codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
  • CPT code 29868; Meniscal transplantation, medical or lateral, knee [any method].

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Selected References: 

  • Stollsteimer, G.T., Shelton, W.R., Dukes, A., Bomboy, A.L. Meniscal allograft transplantation: A 1-5 year follow-up of 22 patients. The Journal of Arthroscopic and Related Surgery 2000; 16(4):343-347.
  • Rodeo, S.A. Meniscal Allografts-Where do we stand?. The American Journal of Sports Medicine 2001; 29(2):246-261.
  • Rath, E., Richmond, J.C. The menisci: basic science and advances in treatment. British Journal of Sports Medicine 2000; 34:252-257.
  • Maitra, R.S, Miller, M.D, Johnson, D.L. A review paper; Meniscal Reconstruction Part II: Outcome potential complications, and future directions. The American Journal of Orthopedics 1999 May; 28(5):280-286.
  • Verdonk, R. Meniscal transplantation.  Acta Orthopaedica Belgica 2002  April;68(2):118-7.
  • Graf KW, Sekiya JK, Wojtys EM et al. Long-term results after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction: minimum 8.5-year follow-up study. Arthroscopy. 2004 Feb;20(2):129-40.
  • Sekiya JK, Giffin JR, Irrgang JJ et al. Clinical outcomes after combined allograft transplantation and anterior cruciate ligament reconstruction. Am J Sports Med. 2003 Nov-Dec; 31(6):896-906.
  • Verdonk PC, Bemurie A, et al. Transplantation of viable meniscal allograft. Survivorship analysis of one hundred cases. J Bone Joint Surg Am 2005 Apr; 87(4):715-24.
  • Matava MJ. Meniscal allograft transplantation: a systematic review. Clin Orthop Relat Res. 2007 Feb;445:142-57.
  • Kim JM, Bin SI. Meniscal allograft transplantation after total meniscectomy of torn discoid lateral meniscus. Arthroscopy. 2006 Dec;22(12):1344-1350.
  • Verdonk PC, Verstraete KL, Almqvist KF et al. Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knne Surg Sports Traumatol Arthrosc. 2006 Aug; 14(8):694-706.
  • Sekiya JK, West RV, Groff YJ et al. Clinical outcomes following isolated lateral meniscal allograft transplantation.  Arthroscopy. 2006 Jul;22(7):771-80.
  • Rue JP, Yanke AB, Busam ML, McNIckle AG, Cole BJ. Perspective Evaluation of Concurrent Meniscus Transplantation and Articular Cartilage Repair: Minimum 2-years Follow-Up. Am J Sports Med. 2008 May 15.[Epub ahead of print]
  • Chang HC, The KL, Leong KL, Mak SL, Karim SA. Clinical Evaluation of Arthroscopic-assisted Allograft Meniscal Transplant. Ann Acad Ned Singapore.2008 Apr;37(4):266-7.
  • ECRI Institute. [Windows report] 2008. Meniscal Allograft Transplantation for Damaged or Removed Meniscus. ECRI Institute. 

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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:

Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave.
Des Moines, IA 50309

*Prior Approval is recommended for this policy.

**Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.