Medicare covers amniotic tissue when used in certain surgeries and for wound care

Medicare covers amniotic tissue when used in certain surgeries and for wound care. For example, if a neurosurgeon wants to use a piece of amniotic membrane (the covering of the birth sac) to patch a hole in the dura or an ophthalmologist wants to use some to treat a defect in the cornea, both of those products will usually be covered by Medicare. In addition, if a wound healing center wants to sprinkle some amniotic membrane onto a non-dealing diabetic skin wound, there is generally coverage for a narrow set of circumstances.

Medicare coverage for Mohs surgery and the use of amniotic membrane depends on specific circumstances and medical necessity. Mohs surgery, a specialized technique for treating skin cancer by removing layers of skin one at a time, may be covered by Medicare if deemed medically necessary and performed by a qualified healthcare provider.

Regarding the use of amniotic membrane in conjunction with Mohs surgery, Medicare coverage would typically depend on the purpose of its application and whether it meets the criteria for reimbursement. If the use of amniotic membrane is considered integral to the surgical procedure and contributes to wound healing or other therapeutic benefits, it may be covered.

However, coverage determinations can vary based on factors such as the individual's medical condition, the specific indications for the use of amniotic membrane, and the policies of the Medicare administrative contractor (MAC) responsible for processing claims in a particular geographic area.

It's essential for patients and healthcare providers to consult with Medicare and/or the MAC to determine coverage eligibility and ensure that all requirements are met for reimbursement. Additionally, obtaining prior authorization or documenting medical necessity may be necessary to facilitate coverage for Mohs surgery and associated treatments involving amniotic membrane.

However, outside of these clinical circumstances, there is usually ZERO coverage for amniotic injection products for things like arthritis, tendinitis, spine, or pain.