Arthroscopy · Knee

Arthroscopic knee surgery for transplantation of a donor meniscus, medial or lateral, including the required arthrotomy for graft insertion.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,512.39
Total RVUs: 45.28
Global, days: 90
Region: Knee

Drawn from CMSAAPCCentralhealthplanCoderoncallFindacode

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Specify medial or lateral compartment — the code covers one side; laterality must be documented explicitly in the operative note.
Document prior meniscectomy (partial or total) as the underlying indication, including when it was performed and by whom.
Confirm absence of advanced osteoarthritis in the affected compartment, supported by imaging findings cited in the pre-op workup.
Describe allograft source, type, and sizing in the operative note; graft preparation and fixation technique must be detailed.
Document that arthrotomy was performed for meniscal insertion — this is included in 29868 but must appear in the operative note to substantiate the bundled component.
Pre-authorization documentation should include failed conservative treatment, patient age and functional demands, and compartment-specific diagnosis codes.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 29868 covers arthroscopic meniscal transplantation of the knee — either medial or lateral compartment — using an allograft. The code bundles the arthrotomy required for meniscal insertion, so that component is never billed separately. This is a high-complexity procedure with a 90-day global period under CMS Physician Fee Schedule 2026.

Not all payers cover meniscal transplantation. Several commercial carriers, including some BCBS plans, have historically classified this procedure as experimental or investigational and denied on that basis. Pre-authorization is standard, and a robust medical necessity letter documenting prior meniscectomy, absence of significant osteoarthritis, patient age and activity level, and failed conservative treatment is non-negotiable before scheduling. ICD-10 diagnosis coding must be precise — derangement of meniscus codes alone are typically insufficient; history of meniscectomy and compartment-specific diagnoses strengthen the claim.

Not billable same-session with 29870, 29871, 29875, 29880, 29883, or 29884 per AAOS guidance and NCCI bundling rules. If chondroplasty is performed in a different compartment during the same session, G0289 (not 29877) is the correct add-on for Medicare patients. Fluoroscopy used intraoperatively is integral to the arthroscopic procedure — do not bill separately.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	24.47
Practice expense RVU	15.62
Malpractice RVU	5.19
Total RVU	45.28
Medicare national rate	$1,512.39
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$1,512.39
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 29868 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Payer classifies meniscal transplantation as experimental or investigational — most common denial vector; requires prior auth and medical necessity letter before claim submission.
Missing or vague laterality documentation — operative note that doesn't specify medial vs. lateral triggers coding review and potential denial.
Unbundling of the arthrotomy for meniscal insertion — 29868 already includes this; billing a separate open arthrotomy code same-session creates an NCCI conflict.
Billing 29877 (chondroplasty) same-session with 29868 — NCCI bundles these; use G0289 for Medicare if chondroplasty is performed in a different compartment.
Insufficient medical necessity documentation — claims without imaging correlation, prior meniscectomy history, and failed conservative treatment are routinely questioned or denied.
Billing 29870, 29871, 29875, 29880, 29883, or 29884 on the same session — these are not separately reportable with 29868 per AAOS and NCCI guidance.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Is 29868 covered by Medicare?

Medicare does not have a national non-coverage determination for 29868, but coverage is determined at the MAC level and individual payer level. Some commercial payers still classify meniscal transplantation as experimental. Verify prior authorization requirements with each payer before scheduling — a denied claim after surgery is difficult to overturn without pre-auth documentation.

02Can 29868 be billed with a meniscectomy code on the same knee same day?

No. Per AAOS guidance and NCCI policy, 29868 cannot be billed with 29880, 29881, 29883, or 29884 at the same session. The transplant is the definitive procedure; meniscectomy codes are bundled.

03Can you bill the arthrotomy separately when it's performed as part of 29868?

No. The code descriptor explicitly includes the arthrotomy for meniscal insertion. Billing a separate open arthrotomy code creates an NCCI conflict and will be denied or recouped on audit.

04What's the correct way to report same-session chondroplasty with 29868?

For Medicare patients, use G0289 only if the chondroplasty is performed in a different compartment of the same knee. Do not bill 29877 — NCCI bundles it with 29868 with a 0 modifier indicator, meaning no modifier override is available.

05Does 29868 cover both medial and lateral transplants, or is it per-side?

The code covers one transplant — medial or lateral — per operative session. Document which compartment explicitly. If both medial and lateral transplants are performed in the same session (rare), contact your payer before billing; there is no established bilateral code convention for this procedure.

06What modifier applies if a meniscal transplant is performed during the global period of a prior unrelated knee procedure?

Use modifier 79 to indicate an unrelated procedure during the postoperative period of a prior surgery. If the transplant is a planned staged procedure following the original surgery, modifier 58 applies instead.

07Is fluoroscopy billable separately when used intraoperatively during 29868?

No. Per NCCI policy, fluoroscopy performed during an arthroscopic procedure is integral to the procedure and cannot be billed separately.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures compartment laterality (medial vs. lateral), allograft type and sizing, fixation method, arthrotomy documentation for graft insertion, and the intraoperative arthroscopic findings for each compartment. That documentation prevents the two most common audit flags: missing laterality and unbundled arthrotomy charges. Pre-authorization language and prior meniscectomy history are also flagged for inclusion in the operative note.

See how Mira captures CPT 29868 documentation