Medicare Benefits Schedule - Item 49521

Complex primary arthroplasty of knee, using revision femoral or tibial components, including either or both of the following (if performed):

(a) ligament reconstruction;

(b) patellar resurfacing;

other than a service associated with a service to which item 48245, 48248, 48251, 48254 or 48257 applies (H)

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $1,823.45 Benefit: 75% = $1,367.60

(See para TN.8.117, TN.8.285 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.

Related Items: 49500 49503 49506 49509 49512 49515 49516 49517 49518 49519 49521 49524 49525 49527 49530 49533 49534 49536 49542 49544 49548 49551 49554 49564 49565 49569 49570 49572 49574 49576 49578 49580 49582 49584 49586 49590

Item 49521 is for a complex primary arthroplasty of the knee where revision components to either the tibia or the femur are used.

Item 49524 is for a complex primary arthroplasty of the knee where revision components to both the tibia and the femur are used.

Item 49524 may also be used in rare circumstances where an anatomic-specific allograft is required as part of a complex primary arthroplasty of the knee.

Related Items: 49521 49524