Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

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 through July 30, 2016).
Medical treatment guidelines: Surgical Guideline for Work-related Knee Injuries 

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