Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

This policy states that injections and/or applications of any amniotic or placental-derived products for musculoskeletal indications (including tendon/ligament injuries, cartilage damage, osteoarthritis, joint/back pain, and adjunctive orthopedic uses) are not covered. The policy does not address burns, wounds, or ophthalmic uses, and cites limited standardization and insufficient human safety/efficacy evidence plus variable FDA regulatory status as the rationale.

"Amniotic membrane, amniotic fluid, or any other placental-derived product injections and/or applications for musculoskeletal injuries, joint conditions, or other musculoskeletal indications are not..."

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