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HumanaMedicare Advantage · Coverage · Medicare Advantage · Orthopedics, Neurosurgery, General Surgery +2 moreMedium impact

Bone Graft Substitutes - Medicare Advantage (Revised)

Effective date
Nov 2, 2026
Identified
Oct 28, 2026

Summary

Humana Medicare Advantage revised its Bone Graft Substitutes policy effective 11/02/2026, reaffirming coverage for autograft, allograft/DBM, ceramic-based synthetics, and rhBMP-2 under specific conditions, while continuing to exclude bioactive glass, bone marrow aspirate (BMA), cell-based/mesenchymal stem cell products, and P-15 peptide products. Billing teams must verify current coverage criteria align with the policy's FDA-approved indication requirements and apply applicable MAC-specific LCDs by jurisdiction.

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What to do

Action · 6 steps
01Effective 11/02/2026: Billing team must update claim submission protocols to enforce the revised coverage criteria.
02Verify autograft (20936), allograft/DBM (20930, 20931), and ceramic-based synthetic bone grafts are billed only when used as bone graft extenders or bone void fillers per FDA-approved indications.
03Confirm rhBMP-2 claims (when billed) are limited to treatment of lumbar degenerative disc disease or acute open tibial fractures only.
04Continue to deny or reject claims for bone marrow aspirate (20939), cell-based/mesenchymal stem cell products, bioactive glass, and P-15 peptide products (i-FACTOR, PearlMatrix) as non-covered.
05Apply the applicable MAC-specific LCD for Platelet Rich Plasma (0232T) based on member geographic jurisdiction (J6, JK, J15, JE, JF, JH, JL, JJ, JM, JN).
06Review billing system configuration to enforce these limitations and prevent submission of non-covered bone graft substitutes.
If missed: Failure to apply these criteria may result in claim denials and member appeals.

Codes mentioned

20936209302093120939

Original notice

Bone Graft Substitutes - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Bone Graft Substitutes - Medicare Advantage (Revised)MediumEffective Feb 2, 2026 · Medicare AdvantageBrowse every Humana change in the policy list

Related policy hubs

Humana policiesOrthopedicsNeurosurgeryGeneral SurgerySports MedicinePM&R (Physical Medicine & Rehab)Code 20936Code 20930Code 20931Code 20939

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