Autologous bone marrow grafting (ABMG) for osteonecrosis

These services may or may not be covered by all CoOportunity Health plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative process

Prior authorization is not applicable for Autologous Bone Marrow Grafting (ABMG) for osteonecrosis because it is considered investigational/experimental. The provider and facility will be liable for payment unless:

• The provider notifies the member that a specific service has been determined by CoOportunity Health to be investigational/experimental; and
• The member signs a waiver agreeing to pay for the specific non-covered service being rendered; and
• The claim has been billed with a GA modifier indicating such. If the member has signed a waiver agreeing to pay for the specific service then the member will be liable for payment.

Autologous bone marrow grafting (ABMG) is not covered for the treatment of osteonecrosis of any joint because there is insufficient scientific literature to support its effectiveness.

Osteonecrosis/avascular necrosis is bone death caused by poor blood supply to the area. It is most common in the hip and shoulder, but can affect other large joints such as knee, elbow, wrist and ankle.

Autologous bone marrow grafting (ABMG) – bone marrow is aspirated from a donor. For the purposes of this policy, the donor bone marrow is applied to the necrotic (dead) bone area via surgical techniques to facilitate growth of healthy bone and healing of the osteonecrosis.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

20999 - Unlisted procedure, musculoskeletal system, general
22899 - Unlisted procedure, spine
23929 - Unlisted procedure, shoulder
26989 - Unlisted procedure, hands or fingers
27299 - Unlisted procedure, pelvis or hip joint
27599 - Unlisted procedure, femur or knee
27899 - Unlisted procedure, leg or ankle
38230 – Bone marrow harvesting for transplantation

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

This information is for most, but not all, CoOportunity Health plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.