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

This policy states that all injections and/or applications of amniotic membrane, amniotic fluid, and other placental-derived products for musculoskeletal indications are not covered as not reasonable and necessary. The non-coverage explicitly includes tendon/ligament injuries, cartilage damage, osteoarthritis, joint and back pain, chronic pain, and adjunctive orthopedic surgical uses; dental uses are also excluded. Burns, wounds, and ophthalmic uses are outside the scope of this policy and may be addressed separately.

"All amniotic membrane, amniotic fluid, or other placental-derived product injections and/or applications for the treatment of any musculoskeletal condition are not covered as not reasonable and nec..."

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