Medicare Advantage Medical Policy Updates 12012025

New Medical Policy

Non-Oncologic Indications for Low Dose Radiation Therapy

Effective Date: 12/01/2025
Preauthorization Required: Yes

Policy Statement:

1. The use of low dose radiation therapy for the diagnosis of osteoarthritis and plantar fasciitis is considered not medically necessary.

 

Medicare Advantage Amniotic Membrane and Amniotic Fluid

Effective Date: 12/01/2025
Preauthorization Required: Yes

Additional Policy Statement:

1. The use of amniotic membrane is considered scientifically validated for the following indications:
   1. Diabetic lower extremity ulcers OR
   2. Neurotrophic keratitis OR
   3. Corneal ulcers and melts OR
   4. Pterygium repair OR
   5. Stevens-Johnson syndrome of the eye OR
   6. Persistent epithelial defects of the eye OR
   7. Difficult to heal chronic venous partial and full-thickness ulcers of the lower extremity that have failed standard wound therapy greater than 4-weeks duration. 
2. The use of human amniotic membrane is considered not medically necessary for all other indications
3. The use of human amniotic fluid injection is considered not medically necessary for all indications.

 

Revised Medical Policy

M.15 Medicare Advantage Following NCD, LCD or Interqual and M.3 Bioengineered Skin and Soft Tissue Substitutes

Effective Date: 01/01/2026
Preauthorization Required: Yes

Additional Policy Statement:

New LCD:  L39865 Skin Substitute Grafts/Cellular Tissue Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers