G0428 Collagen meniscus implantCollagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)
Status N: non-covered service.
1 of 1 payer prior-auth lists that name G0428 require prior authorization or set conditions: UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth required | Jan 1, 2015 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
G0428 appears in 18 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Shield of California, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Menaflex (0786) | not covered | Dec 2, 2025 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) | not covered | Jul 29, 2026 | payer document |
| Anthem | Products for Wound Healing and Soft Tissue Grafting: Investigational (SURG.00011) | unproven / investigational | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Meniscal Allografts And Other Meniscal Implants | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Meniscal Allografts and Other Meniscal Implants | not covered | May 20, 2026 | payer document |
| Blue Shield of California | Meniscal Allografts and Other Meniscal Implants (7.01.15) | listed, no stance | payer document | |
| Cigna | Miscellaneous Musculoskeletal Procedures (0515) | unproven / investigational | Jun 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Meniscal Allografts and Other Meniscal Implants (SUR705.034) | listed, no stance | Jul 1, 2026 | payer document |
| Premera Blue Cross | Meniscal Allografts and Other Meniscal Implants (7.01.15) | listed, no stance | Jun 8, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (2026T0553JJ) | listed, no stance | Sep 10, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (CS068.AD) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (for Kansas Only) (CS068KS.05) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (for Kentucky Only) (CS068KY.13) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (for Nebraska Only) (CS068NE.AD) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (for New Mexico Only) (CS068NM.F) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (for Ohio Only) (CS068OH.G) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (for Pennsylvania Only) (CS068PA.AA) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Surgery of the Knee (for Tennessee Only) (CS068TN.AA) | listed, no stance | Jul 1, 2026 | payer document |
Prior authorization required or conditional in IN.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.