CMS determined that collagen meniscus implant “is not reasonable and necessary for the treatment of meniscal injury/tear and is non-covered by Medicare, as identified in section 150.12 of the National Coverage Determination Manual,” according to the report.
All claims for collagen meniscus implants with dates of service on or after May 25 will be denied, using Claim Adjustment Reason Code 96 and Remittance Advice Remark Code N386.
New HCPCS code G0428 (Collagen or other tissue engineered meniscus knee implant procedure for filling meniscal defects (e.g. collagen scaffold, Menaflex)) has been created for use in non-covered collagen meniscus implant procedures.
Read the MLN Matters article on collagen meniscus implants (pdf).
