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

This LCD disallows coverage of all amniotic- and placental-derived product injections or applications for musculoskeletal indications (including joint, tendon, ligament, cartilage, osteoarthritis, and back/chronic pain) because of limited human clinical evidence and lack of product standardization. Burns, wounds, and ophthalmic uses are outside the scope of this policy and should be considered under the applicable wound/burn/ophthalmic coverage policies; contractors should follow FDA HCT/P regulatory guidance and CMS NCD 110.23 where relevant.

"All injections or applications of amniotic membrane, amniotic fluid, chorion, placenta, Wharton’s jelly, umbilical cord, umbilical cord blood, or any product derived from these tissues are non-cove..."

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