706 Form

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Medical Policy Patient-Specific Instrumentation (eg, Cutting Guides) for Joint Arthroplasty
Table of Contents • Policy: Commercial • Coding Information
• Information Pertaining to All Policies
• Policy: Medicare • Description
• References
• Authorization Information • Policy History

Policy Number: 706 BCBSA Reference Number: 7.01.144 (For Plan internal use only) NCD/LCD: NA

Related Policies
Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedures, #594 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity
Medicare HMO BlueSM and Medicare PPO BlueSM Members

Use of patient-specific instrumentation (eg, cutting guides) for joint arthroplasty, including but not limited to use in unicompartmental or total knee arthroplasty, is considered INVESTIGATIONAL.

Prior Authorization Information
Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient.
Outpatient • For services described in this policy, see below for products where prior authorization might be required if the procedure is performed outpatient.

Outpatient Commercial Managed Care (HMO and POS) This is not a covered service. Commercial PPO and Indemnity This is not a covered service. Medicare HMO BlueSM This is not a covered service. Medicare PPO BlueSM This is not a covered service.

CPT Codes / HCPCS Codes / ICD Codes
Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

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Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable. CPT Codes There is no specific CPT code for this service.

Description Patient-specific instrumentation has been developed as an alternative to conventional cutting guides, with the goal of improving both alignment and surgical efficiency. A number of patient-specific cutting guides are currently being marketed. Patient-specific guides are constructed with the use of preoperative 3- dimensional computed tomography or magnetic resonance imaging scans, which are taken 4 to 6 weeks before the surgery. The images are sent to the planner/manufacturer to create a 3-dimensional model of the knee and proposed implant. After the surgeon reviews the model of the bone, makes adjustments, and approves the surgical plan, the manufacturer fabricates the disposable cutting guides. Summary
Patient-specific instrumentation has been developed as an alternative to conventional cutting guides for joint arthroplasty. Patient-specific cutting guides are constructed with the aid of preoperative 3- dimensional computed tomography or magnetic resonance imaging scans and proprietary planning software. The goals of patient-specific instrumentation are to increase surgical efficiency and to improve implant alignment and clinical outcomes. For individuals who are undergoing partial or total knee arthroplasty who receive patient-specific cutting guides, the evidence includes RCTs, comparative cohort studies, and systematic reviews of these studies. Relevant outcomes of interest are symptoms, functional outcomes, and quality of life. Results from the systematic reviews are mixed, finding significant improvements in some measures of implant alignment but either no improvement or worse alignment for other measures. The available systematic reviews are limited by the small size of some of the selected studies, publication bias, and differences in both planning and manufacturing of the patient specific instrumentation systems. Also, the designs of the devices are evolving, and some of the studies might have assessed now obsolete patient specific instrumentation systems. Available results from individual RCTs have not shown a benefit of patient- specific instrumentation systems in improving clinical outcome measures with follow-up currently extending out to 5 years. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome. Policy History Date Action 5/2026 Policy updated with literature review through February 18, 2026; references added. Policy statement unchanged. 6/2025 Annual policy review. References updated. Policy statements unchanged. 6/2024 Annual policy review. References updated. Policy statements unchanged. 6/2023 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 6/2022 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 5/2021 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 6/2020 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 5/2019 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 7/2018 Annual policy review.
Title changed to Patient-Specific Instrumentation (eg, Cutting Guides) for Joint Arthroplasty.7/1/2018 5/2018 Prior Authorization Information reformatted.

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11/2017 Policy clarified to remove custom knee implants from the policy. 11/14/2017
9/2017 Annual policy review. New references added. 11/2015 Annual policy review. New references added. 2/2015 New medical policy describing investigational indications. Effective 2/1/2015. Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines

References

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37. Kassab S, Pietrzak WS. Patient-specific positioning guides versus manual instrumentation for total knee arthroplasty: an intraoperative comparison. J Surg Orthop Adv. 2014; 23(3): 140-6. PMID 25153812

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38. Khuangsirikul S, Lertcharoenchoke T, Chotanaphuti T. Rotational alignment of femoral component between custom cutting block and conventional technique in total knee arthroplasty. J Med Assoc Thai. Feb 2014; 97 Suppl 2: S47-51. PMID 25518175
39. Kosse NM, Heesterbeek PJC, Schimmel JJP, et al. Stability and alignment do not improve by using patient-specific instrumentation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. Jun 2018; 26(6): 1792-1799. PMID 29181560
40. Kotela A, Kotela I. Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study. Int Orthop. Oct 2014; 38(10): 2099-107. PMID 24968788
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53. Ng VY, DeClaire JH, Berend KR, et al. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res. Jan 2012; 470(1): 99-107. PMID 21809150
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57. Parratte S, Blanc G, Boussemart T, et al. Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation. Knee Surg Sports Traumatol Arthrosc. Oct 2013; 21(10): 2213-9. PMID 23942938
58. Pfitzner T, Abdel MP, von Roth P, et al. Small improvements in mechanical axis alignment achieved with MRI versus CT-based patient-specific instruments in TKA: a randomized clinical trial. Clin Orthop Relat Res. Oct 2014; 472(10): 2913-22. PMID 25024031
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67. PMID 23907610
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69. PMID 31227853
70. Schotanus MGM, Boonen B, van der Weegen W, et al. No difference in mid-term survival and clinical outcome between patient-specific and conventional instrumented total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. May 2019; 27(5): 1463-1468. PMID 29725747
71. Silva A, Sampaio R, Pinto E. Patient-specific instrumentation improves tibial component rotation in TKA. Knee Surg Sports Traumatol Arthrosc. Mar 2014; 22(3): 636-42. PMID 23989707
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73. Stronach BM, Pelt CE, Erickson JA, et al. Patient-specific instrumentation in total knee arthroplasty provides no improvement in component alignment. J Arthroplasty. Sep 2014; 29(9): 1705-8. PMID 24890995
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75. Sun ML, Zhang Y, Peng Y, et al. Accuracy of a Novel 3D-Printed Patient-Specific Intramedullary Guide to Control Femoral Component Rotation in Total Knee Arthroplasty. Orthop Surg. Apr 2020; 12(2): 429-441. PMID 32087620
76. Tammachote N, Panichkul P, Kanitnate S. Comparison of Customized Cutting Block and Conventional Cutting Instrument in Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty. Mar 2018; 33(3): 746-751.e3. PMID 29108794
77. Teeter MG, Marsh JD, Howard JL, et al. A randomized controlled trial investigating the value of patient-specific instrumentation for total knee arthroplasty in the Canadian healthcare system. Bone Joint J. May 2019; 101-B(5): 565-572. PMID 31038991

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76. Thienpont E, Grosu I, Paternostre F, et al. The use of patient-specific instruments does not reduce blood loss during minimally invasive total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc. Jul 2015; 23(7): 2055-60. PMID 24671387
77. Turgeon TR, Cameron B, Burnell CD, et al. A double-blind randomized controlled trial of total knee replacement using patient-specific cutting block instrumentation versus standard instrumentation. Can J Surg. Dec 01 2019; 62(6): 460-467. PMID 31782643
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82. Woolson ST, Harris AH, Wagner DW, et al. Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Joint Surg Am. Mar 05 2014; 96(5): 366-72. PMID 24599197
83. Yaffe M, Luo M, Goyal N, et al. Clinical, functional, and radiographic outcomes following total knee arthroplasty with patient-specific instrumentation, computer-assisted surgery, and manual instrumentation: a short-term follow-up study. Int J Comput Assist Radiol Surg. Sep 2014; 9(5): 837-
84. PMID 24337791
85. Yan CH, Chiu KY, Ng FY, et al. Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. Dec 2015; 23(12): 3637-45. PMID 25217311
86. Zahn RK, Graef F, Conrad JL, et al. Accuracy of tibial positioning in the frontal plane: a prospective study comparing conventional and innovative techniques in total knee arthroplasty. Arch Orthop Trauma Surg. Jun 2020; 140(6): 793-800. PMID 32124032
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90. Braun S, Allen J, Somerville L, et al. Patient-Specific Instrumentation Versus Standard of Care in Total Knee Arthroplasty in an Obese Population: Minimum 5-year Follow-Up. J Arthroplasty. Feb 2026; 41(2): 458-464. PMID 40562084
91. Hermodsson J, Saari T, Shareghi B, et al. Effect of patient specific instruments compared with conventional instruments in total knee arthroplasty : a randomized controlled trial. Acta Orthop. Dec 02 2025; 96: 875-884. PMID 41329855
92. Hampton MJ, Blakey CM, Anderson AA, et al. Minimum 5-Year Outcomes of a Multicenter, Prospective, Randomized Control Trial Assessing Clinical and Radiological Outcomes of Patient- Specific Instrumentation in Total Knee Arthroplasty. J Arthroplasty. Aug 2022; 37(8): 1579-1585. PMID 35077818
93. McGrory BJ, Weber KL, Jevsevar DS, et al. Surgical Management of Osteoarthritis of the Knee: Evidence-based Guideline. J Am Acad Orthop Surg. Aug 2016; 24(8): e87-93. PMID 27355286
94. American Academy of Orthopaedic Surgeons Surgical Management of Osteoarthritis of the Knee Evidence-Based Clinical Practice Guideline. https://www.aaos.org/quality/quality-programs/clinical- practice-guidelines/. Published December 02, 2022. Accessed February 19, 2026.