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E495 – Meniscectomy, partial or total, for symptomatic meniscal tear

OHIP Musculoskeletal System Surgical Procedures Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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E495 represents a meniscectomy, which can be either partial or total, performed for a symptomatic meniscal tear. Prior approval may be granted for this procedure in patients with Kellgren-Lawrence grade 3 or 4 osteoarthritis if the clinical record supports: • Significant functional impairment caused by an unstable articular chondral flap or degenerative meniscal tear which has not responded to a minimum of six months active non-surgical treatment; and • The patient is not a current candidate for knee realignment or arthroplasty.
Pre-authorization required
When E495 is claimed with R687, it is recommended that the intra-articular pathology be documented with pre- and post-procedural photographic images taken during arthroscopy which are archived in the permanent medical record where possible.
R687

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