All PlansCoverageMedium impact
Amniotic Membrane and Amniotic Fluid
Blue Cross & Blue Shield of Mississippi·MS · Wound Care, Ophthalmology, Podiatry +2 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a comprehensive medical policy defining coverage criteria for amniotic membrane and amniotic fluid products. The policy establishes that specific HAM products (Affinity, AmnioBand, Biovance, EpiCord, EpiFix, Grafix, NuShield) may be considered medically necessary for nonhealing diabetic lower-extremity ulcers, and HAM grafts are covered for specific ophthalmic conditions like neurotrophic keratitis and corneal ulcers when conservative therapy fails.
Action Required
Immediately: Review current amniotic membrane billing practices to ensure only the specified products (Affinity, AmnioBand, Biovance, EpiCord, EpiFix, Grafix, NuShield) are billed for diabetic ulcers. Verify documentation supports medical necessity criteria outlined in policy for both wound care and ophthalmic applications. Update prior authorization protocols to align with coverage requirements.