Medicare Benefits Schedule - Item 49565

Reconstruction of patellofemoral joint of knee, by combined open and arthroscopic means, including:

(a) both of the following:

(i) medial soft tissue reconstruction;

(ii) tibial tuberosity transfer; and

(b) any of the following (if performed):

(i) bone graft;

(ii) internal fixation;

(iii) trochleoplasty;

other than a service associated with a service to which another item of this Schedule applies if the service described in the other item is for the purpose of performing a procedure on the knee by arthroscopic means (H)

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $1,502.75 Benefit: 75% = $1,127.10

(See para TN.8.117 of explanatory notes to this Category)

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The Medical Services Advisory Committee (MSAC) evaluated the available evidence and did not support public funding for matrix-induced autologous chondrocyte implantation (MACI) or autologous chondrocyte implantation (ACI) for the treatment of chondral defects in the knee and other joints, due to the increased cost compared to existing procedures and the lack of evidence showing short term or long-term improvements in clinical outcomes. Medicare benefits are not payable in association with this technology as per GN.13.33.

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