Effective Jan. 1, 2027, Sanford Health Plan will begin covering osteochondral knee allograft procedures for commercial members when medical necessity criteria are met and prior authorization is approved.

This service is currently considered experimental or investigational; however, beginning January 1, eligible requests will be reviewed through the prior authorization process to determine medical necessity.

Covered CPT Codes

• 27415: Osteochondral allograft, knee, open procedure
• 29867: Arthroscopy, knee, osteochondral allograft transplantation

Coverage requirements

• Prior authorization is required for all osteochondral knee allograft procedures.
• Coverage applies to Sanford Health Plan commercial members.
• Requests must meet established medical necessity criteria and include supporting clinical documentation.
• Standard member cost-sharing, including applicable copayments, deductibles and coinsurance, will apply according to the member's benefit plan.

This change reflects Sanford Health Plan's review of current clinical evidence and expands treatment options for members who may benefit from osteochondral knee allograft procedures. Providers are encouraged to submit authorization requests before scheduling services to ensure timely coverage determinations.