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

This policy states that injections or applications of any amniotic or placental-derived products for musculoskeletal indications (e.g., tendon/ligament injuries, osteoarthritis, joint or back pain) are not covered due to limited evidence and product heterogeneity. Burns, wounds, and ophthalmic uses are excluded from this determination, and product regulatory status under FDA HCT/P Section 361 and donor infectious disease screening should be documented; stem cell transplantation is addressed under CMS NCD 110.23.

"All injections or applications of amniotic membrane, amniotic fluid, chorion, placenta, Wharton’s jelly, umbilical cord, umbilical cord blood, or any other placental-derived product for musculoskel..."

Sign up to see full coverage criteria, indications, and limitations.