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Osteochondral Allograft/Autograft Transplantation (OAT)

Osteochondral autograft and allograft transplantations are surgeries that attempt to restore the biomechanical and physiologic cartilage functions of the joint.  Autograft transplantation involves harvesting bone and intact articular cartilage from a non-weight-bearing portion of a joint from the patient (i.e., autologous tissue) to fill a defect in the weight-bearing portion of the joint. Allograft transplants involve the transplantation of a piece of cartilage and subchondral bone from a source outside of the patient to fill in the osteochondral defect.

Coverage decision: OAT is covered with conditions (Effective date: October 1, 2012).

Note: OAT for joints other than the knee, such as the shoulder, the elbow and the ankle, is not covered.

Background Policy Information

The State Health Technology Clinical Committee (HTCC) reviewed OAT on November 18, 2011. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that OAT is a covered benefit with conditions.  Complete information on this HTCC determination is available here: http://www.hca.wa.gov/hta/Pages/Forms/HTA_Findings.aspx.

Authorization requirements


Is authorization required?

How do I get pre-authorization?

Yes

L&I (State fund):
Request Utilization Review provided by Qualis

Self-insured:
Contact the employer or its third party administrator

 

Regulatory authority and related information

 

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