CMM-612: Grafts

RhBMP‑2 (InFuse®) is covered only for narrowly defined high‑risk spinal fusions—anterior/posterior cervical fusion for neuromuscular scoliosis or occipitocervical pathology, stand‑alone ALIF in skeletally mature patients, and PLF/PLIF/TLIF when documented high risk for fusion failure or inadequate autograft exists—while BMAC is covered only for postero‑lateral lumbar fusion when used as a hybrid/composite graft with autologous iliac crest bone; numerous other uses, many orthobiologic substitutes (e.g., rhBMP‑7, most cell‑based products, certain allograft/synthetic grafts) and routine/appendicular indications are explicitly not medically necessary. Key requirements: rhBMP‑2 requests must document absence of contraindications (e.g., pregnancy/allergy) and meet the procedure‑specific high‑risk criteria, and BMAC must be harvested by the sequential/Muschler technique, combined with autologous ICBG, used only for posterolateral lumbar fusion, with documentation excluding infection/neoplasm and justifying autograft unavailability or inadequacy.