Use of i-Factor Peptide Enhanced Bone Graft During Spinal Surgery

This policy addresses use of i‑Factor peptide‑enhanced bone graft as a substitute for autologous bone during single‑level anterior cervical discectomy and fusion (ACDF) in skeletally mature adults with cervical degenerative disc disease causing radiculopathy or single‑level myelopathy (C3–C4 to C6–C7), typically after ≥6 weeks of failed conservative therapy and with radiographic confirmation. Major limitations include restriction to single‑level ACDF (not multilevel or lumbar), evidence limited to comparisons with local autograft, and the policy states the product is considered experimental/investigational and not covered; the medical policy is also inactive and must not be used for current claims adjudication.

"Replacement or augmentation of autologous bone in spinal fusion procedures that incorporate interbody fusion devices."

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