Many ASIPP members have recently been approached by sales representatives claiming that amniotic or umbilical cord tissue products are now covered by Medicare and many private insurers for intraarticular injections and interventional pain management procedures.

Based on collective evidence, unfortunately, these claims appear to be INACCURATE, subjecting patients and providers to high risk.

Amnion is covered for limited cutaneous wound healing applications and for a handful of neurosurgical and ophthalmic surgical uses, it has a product reimbursement code (also known as a Q code). If a physician submits the right combination of ICD-10 and CPT codes, Medicare may pay these claims.

Based on review of Medicare local coverage determination (LCD) documents, biologics for intraarticular injections and interventional pain management procedures are Experimental and Investigational. Hence, there is NO coverage for these products for intraarticular injections and interventional pain management procedures. 

It’s the recommendation of ASIPP that you avoid billing Medicare and private insurance for these products when used to treat orthopedic and pain management conditions. Our concern is that by billing these products to a federal program like Medicare, not only could there be significant Medicare clawbacks, but knowingly billing Medicare for products that you know are not covered can result in serious criminal penalties. Even, initial losses could be extensive.

For additional information on coverage guidelines from many private insurers that state that these products are NOT covered, experimental and investigational. Please check the websites of commercial carriers.