Spinal Fusion and Bone Healing Enhancement Products – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers autograft (including BMA), DBM when not combined with listed unproven additives, and most allograft-based products as medically necessary, but deems many biologics/devices (e.g., cell-based allografts/MSC, human amniotic tissue, ceramics, bioactive glass, expandable interbody systems) unproven/not medically necessary; InFUSE (rhBMP‑2) is covered only for single‑level anterior/oblique interbody fusions L2–S1 in skeletally mature adults with DDD and ≤ grade 1 spondylolisthesis using an FDA‑approved interbody device, and InFUSE/MASTERGRAFT™ posterolateral use is limited to FDA‑indicated posterolateral pseudoarthrosis when autograft is not feasible. Coverage requires documentation proving the specific clinical criteria (diagnosis, levels, surgical approach, skeletal maturity, spondylolisthesis grade, prior graft infeasibility) and consistency with member benefit terms and FDA indications.

"Autografts [including Bone Marrow Aspirate (BMA) used for bone grafting]"