UnitedHealthcare Autologous Chondrocyte Implantation prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112), for PPO plans. Yes. UnitedHealthcare generally requires prior authorization for Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112).
Medical-necessity criteria UnitedHealthcare generally applies
Prior authorization required. Per UnitedHealthcare Commercial & Individual Exchange Medical Policy "Surgery of the Knee" (2026T0553II, eff 6/1/2026), autologous chondrocyte implantation (ACI/MACI; CPT 27412, drug J7330, harvest S2112) is a covered, PA-required service in the "Cartilage implants" category. UHC does not publish its own ACI medical-necessity thresholds; medical necessity is delegated to InterQual CP: Procedures [NEEDS VERIFICATION - InterQual is portal-licensed, not public]. Do not represent any specific lesion-size, age/skeletal-maturity, or failed-prior-therapy threshold as a published UHC criterion. NOTE: standard ACI/MACI is NOT on UHC's unproven list - the exclusions below are other (non-ACI) cartilage-repair techniques.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Autologous Chondrocyte Implantation. Confirm the covered diagnosis list against the current UnitedHealthcare policy.
Related procedure codes
Codes often billed alongside Autologous Chondrocyte Implantation: 27412, J7330, S2112. Verify the correct codes for your documentation.
Commonly required documentation
- Documentation of symptomatic full-thickness cartilage defect, prior treatment history, and skeletal maturity per the referenced InterQual checklist
- imaging/arthroscopy findings
- biopsy/harvest (S2112) and implant (J7330) details. Specific thresholds are InterQual-gated (not public).
Situations to verify before submitting
UnitedHealthcare may not cover Autologous Chondrocyte Implantation in these situations. Verify against the current policy rather than assuming a denial:
- Autologous minced or particulated cartilage (e.g., Cartilage Autograft Implantation System, Reveille Cartilage Processor) - unproven and not medically necessary
- Allogeneic minced or particulated cartilage (e.g., BioCartilage, DeNovo NT Graft, DeNovo ET Graft) - unproven and not medically necessary
- Collagen Meniscus Implant - unproven and not medically necessary
- Decellularized osteochondral allografts (e.g., Chondrofix) - unproven and not medically necessary
- Reduced osteochondral discs (e.g., ProChondrix, Cartiform) - unproven and not medically necessary
- Synthetic resorbable polymers (e.g., PolyGraft BGS, TruFit, TruGraft) - unproven and not medically necessary
- Xenograft implantation - unproven and not medically necessary
How to submit
- Method: portal
- Portal: UnitedHealthcare Provider Portal
Sources & verification
- BindingSource — Surgery of the Knee - Commercial & Individual Exchange Medical Policy (2026T0553II) · effective 2026-06-01.View
- BindingSource — Commercial Advance Notification / Prior Authorization Requirements (Cartilage implants category) (PCA-1-24-01315) · effective 2026-01-01.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-21.
Frequently asked questions
Does UnitedHealthcare require prior authorization for Autologous Chondrocyte Implantation?
Yes. UnitedHealthcare generally requires prior authorization for Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112).
What does UnitedHealthcare require to approve Autologous Chondrocyte Implantation?
Prior authorization required. Per UnitedHealthcare Commercial & Individual Exchange Medical Policy "Surgery of the Knee" (2026T0553II, eff 6/1/2026), autologous chondrocyte implantation (ACI/MACI; CPT 27412, drug J7330, harvest S2112) is a covered, PA-required service in the "Cartilage implants" category. UHC does not publish its own ACI medical-necessity thresholds; medical necessity is delegated… Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
Turnaround varies by plan and submission method. Check the UnitedHealthcare portal for current timeframes.
Submitting Autologous Chondrocyte Implantation to UnitedHealthcare?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.