Wiki stem cell

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Titali80

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We had patient about 50 year old with osteoarthritis. High risk for pt. to go for knee replacement. My physician did case write up to united health care
for stem cell injection. It has been denied.

Now my role is to see what can I code for stem cell injection. (removing fat from abdomen) and injecting into knee.
I am having very difficult time getting anything approved. my doctor is pissed and mad.. for not getting PRP injection being paid.

any help I am so clueless.... what to do next and how to?? what to code for? and how much to get compensated for prp/stem cell injection.

any kind soul will help??
Thank you..
 
It's not going to be covered no matter what you do or what he writes. It would need to be cash pay.
0565T Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation
0566T Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral

Example: UHC MCR Policy 0565T: https://www.uhcprovider.com/content...edadv-guidelines/c/category-iii-cpt-codes.pdf (see page 9 for non-covered)
Example UHC Commercial Policy: Autologous Cellular Therapy is unproven and not medically necessary for all indications due to insufficient evidence of efficacy - https://www.uhcprovider.com/content...-medical-drug/autologous-cellular-therapy.pdf
Example Anthem: https://www.premera.com/medicalpolicies/8.01.52.pdf


It's considered investigational, generally no payer is going to pay for it except "possibly" a work comp carrier if prior auth was obtained.
 
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