Bone Graft Substitutes - Medicare Advantage

This Humana Medicare Advantage medical coverage policy specifies that autograft, allograft, calcium phosphate ceramics, calcium sulfate-calcium composite ceramics, DBM, and selected rhBMP-2 uses are considered medically reasonable and necessary when used per FDA-approved labeling and when specific clinical criteria are met. A broad list of bone graft substitutes and biologic products (including many combination products, cell-based products, bone marrow aspirate mixes, beta-tricalcium phosphate variants, bioactive glass, P-15 products, and certain rhBMP-2 uses and procedures) are explicitly not considered medically reasonable and necessary. Documentation must demonstrate adherence to FDA indications, patient eligibility (eg, skeletal maturity), procedural specifics (eg, intramedullary fixation timing, approved cages and surgical approach for rhBMP-2), and absence of listed contraindications; Humana defers to applicable MAC LCDs/LCAs.

"Demineralized bone matrix (DBM) for enhancement of bone healing"