Mesenchymal stem cells (MSCs) are multipotent cells (also called stromal multipotent cells) thatcandifferentiate into various tissues including organs, trabecular bone, tendon, articular cartilage, ligaments, muscle, and fat. MSCs are associated with the blood vessels within bone marrow, synovium, fat, and muscle, where they can be mobilized for endogenous repair as occurs with healing of bone fractures. Stimulation of endogenous MSCs is the basis of procedures such as bone marrow stimulation (e.g., microfracture) and harvesting/grafting of autologous bone for fusion.
The following orthopedic applications are considered experimental investigational and therefore non-covered. Scientific evidence does not support the use of these procedures in the peer-reviewed literature.
| 20932 | 20933 | 20934 | 38206 | 38230 | 38232 | 38241 |
Not Applicable
Not Applicable
Internal Medical Policy Committee 3-16-2020 Annual Review
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.