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Patient insurance approval process

MyCartilageCare can provide patient support by helping to manage the insurance process. MyCartilageCare provides patient benefit investigation, predetermination and prior authorization assistance, and reimbursement support.

Step 1

Download and complete Patient Enrollment Form. Submit Patient Enrollment Form and all requested documentation to MyCartilage Care. For transcription guidance, please see the MyCartilage Care Dictation Roadmap, located in the Resource Library below.

Step 2

From the list below, select patient’s specific insurance carrier for medical inclusion criteria (if carrier is not listed, please call MyCartilage Care at 877-872-4643 for more information). For patients who do not meet the specific criteria of their insurer, additional documentation should be submitted with the Patient Enrollment Form. Letter of Medical Necessity Guidance, Letter of Medical Necessity Template, and Patella Clinical Packet are in the Resource Library below.

Please choose patient insurer:

Step 3

Fax the completed patient enrollment form to MyCartilageCare at 855-803-9485.

Insurance approval is defined as payor pre-authorization for the MACI procedure. Nothing contained herein is intended, nor should it be construed, to suggest a guarantee of coverage or reimbursement for any product or service. Check with the individual insurance provider regarding coverage.

Resource library

Materials are available to help support insurance reimbursement and billing. Additional questions may be directed to MyCartilageCare at 877-872-4643.

I am a patient and my doctor has taken a biopsy of my knee cartilage for MACI

A MyCartilageCare Case Manager

A dedicated MyCartilageCare Case Manager is committed to offering comprehensive support tailored to your individual insurance requirements and treatment goals. Call 877-872-4643 or email info@MyCartilageCare.com.

Patient authorization is required to store biopsies and assist with insurance approval. To download authorization forms to submit via mail or fax, click here.

Indication and Important Safety Information

Important Safety Information

MACI is contraindicated in patients with a known history of hypersensitivity to gentamicin, other aminoglycosides, or products of porcine or bovine origin. MACI is also contraindicated for patients with severe osteoarthritis of the knee, inflammatory arthritis, inflammatory joint disease, or uncorrected congenital blood coagulation disorders. MACI is also not indicated for use in patients who have undergone prior knee surgery in the past 6 months, excluding surgery to procure a biopsy or a concomitant procedure to prepare the knee for a MACI implant.

MACI is contraindicated in patients who are unable to follow a physician-prescribed post-surgical rehabilitation program.

The safety of MACI in patients with malignancy in the area of cartilage biopsy or implant is unknown. Expansion of present malignant or dysplastic cells during the culturing process or implantation is possible.

Patients undergoing procedures associated with MACI are not routinely tested for transmissible infectious diseases. A cartilage biopsy and MACI implant may carry the risk of transmitting infectious diseases to healthcare providers handling the tissue. Universal precautions should be employed when handling the biopsy samples and the MACI product.

Final sterility test results are not available at the time of shipping. In the case of positive sterility results, health care provider(s) will be contacted.

To create a favorable environment for healing, concomitant pathologies that include meniscal pathology, cruciate ligament instability and joint misalignment, must be addressed prior to or concurrent with the implantation of MACI.

Local treatment guidelines regarding the use of thromboprophylaxis and antibiotic prophylaxis around orthopaedic surgery should be followed. Use in patients with local inflammations or active infections in the bone, joint, and surrounding soft tissue should be temporarily deferred until documented recovery.

The MACI implant is not recommended during pregnancy. For implantations post-pregnancy, the safety of breast feeding to infant has not been determined.

Use of MACI in pediatric patients (younger than 18 years of age) or patients over 65 years of age has not been established.

The most frequently occurring adverse reactions reported for MACI (≥5%) were arthralgia, tendonitis, back pain, joint swelling, and joint effusion.

Serious adverse reactions reported for MACI were arthralgia, cartilage injury, meniscus injury, treatment failure, and osteoarthritis.

Please see Full Prescribing Information for more information.

Indication

MACI® is an autologous cellularized scaffold product that is indicated for the repair of single or multiple symptomatic, full-thickness cartilage defects of the adult knee, with or without bone involvement.

MACI® (autologous cultured chondrocytes on porcine collagen membrane) is an autologous cellularized scaffold product that is indicated for the repair of single or multiple symptomatic, full-thickness cartilage defects of the adult knee, with or without bone involvement.

MACI is intended for autologous use and must only be administered to the patient for whom it was manufactured. The implantation of MACI is to be performed via an arthrotomy to the knee joint under sterile conditions.

The amount of MACI administered is dependent upon the size (surface in cm2) of the cartilage defect. The implantation membrane is trimmed by the treating surgeon to the size and shape of the defect, to ensure the damaged area is completely covered, and implanted cell-side down.

Limitations of Use

Effectiveness of MACI in joints other than the knee has not been established.

Safety and effectiveness of MACI in patients over the age of 55 years have not been established.