CommercialCoverageHigh impact
Autologous Chondrocyte Implantation (ACI) 7.01.38
Excellus BlueCross BlueShield·Orthopedics, Sports Medicine·Bone & Joints (Orthopedic)
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their policy for Autologous Chondrocyte Implantation (ACI) effective October 15, 2025, establishing specific medical criteria including BMI limits, age restrictions, and required imaging findings for coverage approval. The policy defines when ACI is medically appropriate versus not medically necessary, and declares hybrid ACI/OATS procedures as investigational.
Action Required
Before October 15, 2025: Billing team must implement pre-authorization requirements for all ACI procedures with Excellus BCBS. Create documentation checklist requiring BMI ≤35, age 15-55, Kellgren-Lawrence Grade II or less radiographs, MRI/CT/arthroscopy with Outerbridge Grade III-IV findings, defect size 1-10cm², stable knee exam, and 3+ months failed conservative treatment. Update encounter forms to capture all required criteria. Claims without meeting ALL specified criteria will be denied.