CommercialCoverageHigh impact
Bone Morphogenetic Protein
Blue Cross & Blue Shield of Mississippi·MS · Orthopedics, Neurosurgery, General Surgery·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes coverage criteria for recombinant human bone morphogenetic protein-2 (Infuse™) for specific spinal fusion procedures and tibial fractures, but only when autograft is not feasible. The policy explicitly states that rhBMP-2 is investigational for all other uses including when autograft IS feasible.
Action Required
Immediately: Billing team must implement prior authorization requirements for all rhBMP-2 (Infuse™) procedures. Verify medical necessity documentation shows autograft is not feasible before billing. Update encounter forms to require providers to document why autograft cannot be used. Claims for rhBMP-2 when autograft is feasible will be denied as investigational.