CMM-612: Grafts Guidelines

rhBMP‑2 (InFuse®) is covered for stand‑alone ALIF (except males with strong reproductive priority) and for PLIF/TLIF/posterolateral lumbar fusions when ONE or more specified high‑risk factors for fusion failure are present, while BMAC is only covered as part of hybrid/composite grafting with autologous iliac crest bone graft for posterolateral lumbar fusion; many other uses of rhBMP‑2 and BMAC (including routine pediatric/cervical fusions, use near neoplasm, pregnancy, infection, spinal malignancy, and numerous BMAC applications) are excluded or considered investigational. Prior authorization is required and clinicians must document the listed high‑risk indications or lack/poor quality of autograft, exclude contraindications, and for BMAC specifically document adherence to the defined sequential aspiration and processing technique.

"Metabolic or other conditions when traditional, autogenous bone grafting has a high risk of failure (ONE or MORE of the following): Alcohol Use Disorder (AUD)."