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Response to Comments: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
A59893
First Coast Service Options, Inc. (J09)
Effective: October 17, 2024
Updated: December 31, 2025
Policy Summary
Coverage for amniotic and placental-derived product injections/applications for non-wound musculoskeletal indications is determined based on evidence of general acceptance in the medical community, prioritized from peer-reviewed original research, systematic reviews, meta-analyses, consensus statements, and clinical guidelines. Anecdotal or unpublished information has limited influence on coverage decisions, and specific claim-level documentation or frequency limits are not specified in this response summary and require review of the final LCD DL39877.
Coverage Criteria Preview
Key requirements from the full policy
"Coverage determinations for amniotic and placental-derived product injections or applications for musculoskeletal, non-wound indications are made only when there is evidence of general acceptance i..."
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