Medicare Not Covering Injected Manipulated Amniotic and/or Placental Tissue Biologics | News | APMA
Medicare Not Covering Injected Manipulated Amniotic and/or Placental Tissue Biologics

February 28, 2022

Medicare Part B and cash

Last week, multiple Part B Medicare Administrative Contractors provided notice that Medicare does not cover manipulated amniotic and/or placental tissue biologics for injections to treat illness because they are deemed experimental, and claims for these services will be denied.

They added that any claims processed and paid for dates of service on or after December 6, 2019, will be adjusted, and payment will be recouped. Impacted providers will receive an overpayment demand letter identifying the amount of the overpayment. These adjustments are considered a write-off for the provider and may not be billed to the patient unless a valid Advanced Beneficiary Notice of Non-Coverage has been executed.

APMA is already in the process of gathering information and resources it can use to challenge this determination.

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