Cigna Medical Coverage Policy - SuperCoder

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Page 1 of 75 Coverage Policy Number: 0068 Cigna Medical Coverage Policy Subject Tissue-Engineered Skin Substitutes Effective Date ............................ 9/15/2014 Next Review Coverage Policy Number ................. 0068 Table of Contents Coverage Policy ........................................ .......... 1 General Background ........................................ . 12 Coding/Billing Information ................................. 45 References ........................................ ................ 62 Hyperlink to Related Coverage Policies Allograft Transplantation of the Knee Autologous Platelet Derived Growth Factors (Platelet-Rich Plasma [PRP]) Becaplermin (Regranex ) Bone Graft Substitutes for Use in Bone Repair Breast Reconstruction Following Mastectomy or Lumpectomy Electrical Stimulation Therapy and Devices Hyperbaric Oxygen Therapy, Systemic & Topical Lumbar Fusion for Spinal Instability and Degenerative Disc Conditions, Including Sacroiliac Fusion Negative Pressure Wound Therapy/Vacuum-Assisted Closure (VAC) for Non-Healing Wounds Plantar Fasciitis Treatments Pulsed Electromagnetic Therapy Scar Revision INSTRUCTIONS F

significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy.

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