Bone Graft Substitutes - (0118)

Cigna covers autografts, allograft-based materials (including DBM), ceramic/polymer synthetics, certain inorganic xenografts (when used alone or with a covered substitute), and antimicrobial‑eluting bone void fillers for enhancement of bone healing, and authorizes rhBMP‑2 (INFUSE) only for surgical repair of acute open tibial shaft fractures; rhBMP‑7, cell‑based products, concentrated bone marrow aspirate, human amniotic membrane products, iliac‑crest backfill, dental‑implant–related grafting, subchondral calcium phosphate (SubChondroplasty), and other specified uses are considered experimental/investigational/unproven and excluded. Coverage requires documentation of covered diagnosis/procedure codes and specific clinical criteria—for rhBMP‑2: operative notes showing IM nail fixation after wound management, application within 14 days, and skeletal maturity; for antimicrobial‑eluting fillers: use as an adjunct to systemic antibiotics and surgical debridement in skeletally mature patients—and spine indications are delegated to EviCore with compliance to their guidelines.