Bone and Tendon Graft Substitutes and Adjuncts

Aetna covers INFUSE Bone Graft only for lumbar fusion in skeletally mature patients who meet CPB 0743 criteria and when implanted via anterior (ALIF) or lateral (OLIF/DLIF/XLIF/LLIF) approaches, and for acute open tibial shaft fractures in skeletally mature patients stabilized with intramedullary nailing and treated with INFUSE within 14 days; cadaveric allograft and demineralized bone matrix are covered for spinal fusions and bone void fillers (100% bone allografts covered regardless of shape), PMMA or calcium sulfate antibiotic beads are covered when used with IV antibiotics for chronic osteomyelitis, and bone marrow injections are covered for unicameral (simple) bone cysts. INFUSE is experimental/investigational for all other indications (including ankle and cervical fusions), bone marrow aspirate is experimental for other orthopedic uses (nonunion, tissue regeneration, osteoarthritis, adjunct to fusion), and autologous PRP/platelet gel/platelet-derived growth factors are experimental for chronic wound healing.