CMM-612: Grafts Guidelines

RhBMP‑2 (InFuse®) is covered only for specified spinal fusion indications (e.g., stand‑alone ALIF except males with strong reproductive priority; PLF/PLIF/TLIF for patients with one or more high‑risk fusion‑failure factors such as revision pseudarthrosis, compromised graft bed, multilevel >3 segments, thoracolumbar deformity, Meyerding grade ≥III ALIF, certain metabolic risks, or unavailable/poor autograft) and is excluded for routine cervical fusions, most pediatric/adolescent fusions, use near neoplasms, pregnancy/infection/hypersensitivity, and non‑spinal (appendicular) indications. BMAC is only medically necessary when used as hybrid/composite grafting with autologous iliac crest corticocancellous bone but is experimental/investigational as an autograft substitute or for cervical/thoracic/anterior fusions and decompression without fusion; prior authorization (CMM‑600.1) plus documentation of the specific procedure, Meyerding grade where applicable, justification of high‑risk status or autograft insufficiency, and for BMAC the Muschler sequential aspiration technique, total volumes (80–100 cc) and ≤2 mL per iliac site are required.