INTERPRETIVE AND POLICY STATEMENT
LABOR AND INDUSTRIES
If you have any questions or need additional information, please call Carmen Moore at (360) 902-4206.
Health Service Analysis Program
Provider Bulletin 03-02 effective February 19, 2003, for state fund and self-insurance claims.
1. Coverage of Autologous Chondrocyte Implantation (ACI). ACI is a covered procedure for selected patients who meet specific criteria. Physicians must request authorization prior to conducting the procedure.
The surgical procedure is used to treat patients with cartilaginous defects of the femoral condyle. The ACI process involves:
|•||Obtaining healthy chondrocyte cells from a patient's knee.|
|•||Culturing the cells through a process termed Carticel.|
|•||Implanting the cultured chondrocytes back into the patient via a surgical procedure.|
The surgical procedure involves grafting a donor meniscus into the knee of a patient who has failed a previous meniscal repair procedures for meniscectomy. The replacement meniscus may help reestablish load bearing, shock absorption, and joint stability.
3. Noncoverage of Microprocessor-controlled Prosthetic Knees. Microprocessor-controlled prosthetic knees, such as the Otto Bock C-Leg, Endolite Intelligent Prosthesis Plus, or Endolite Adoptive Prosthesis, are not covered devices at this time.
Microprocessor-controlled prosthetic knees for above-the-knee amputees use computers to enhance basic mechanical knee designs. They are intended to facilitate amputee response to changing conditions while ambulating. However, the small number of studies on computerized knee prostheses does not substantially show the devices' effectiveness for:
|•||Reducing energy expenditure.|
|•||Improving ability to walk on uneven ground.|
|•||Improving ability to climb and descend stairs.|
|•||Increasing walking distance.|
The UniSpacer is a small, kidney shaped insert made of cobalt chrome for patients with early stage osteoarthritis of the knee. The UniSpacer is intended to relieve pain and to improve joint stability by restoring ligament tension and normal knee alignment.
CONTACT PERSON (for a copy of the Provider Bulletin): Grace Wang, MS 4321, phone (360) 902-4206.
Carmen Moore, Rules Coordinator
Legislative and Governmental Affairs Office