Cigna prior authorization for 1095T*: Harvesting and processing of autologous bone marrow aspirate concentrate (BMAC), with application onto scaffold or injection into anatomical recipient site (eg, subchondral bone, joint space, chondral lesion), including imaging guidance, when performed, for therapeutic musculoskeletal treatment, excluding spinal procedures
Code
1095T*
Description
Harvesting and processing of autologous bone marrow aspirate
concentrate (BMAC), with application onto scaffold or injection into
anatomical recipient site (eg, subchondral bone, joint space, chondral
lesion), including imaging guidance, when performed, for therapeutic
musculoskeletal treatment, excluding spinal procedures
Source
Master Precertification List
For Health Care Providers, Pg 17 Original policy
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