The North American Spine Society released revised coverage recommendations for recombinant human bone morphogenetic protein BMP-2, the Burr Ridge, Ill.-based organization said Aug. 4.
The update gives providers a basis for appropriate use of rhBMP-2, including select off-label indications now supported by data, and gives payers a standard to build medical policy around, said Dr. Mohamad Bydon, co-chair of NASS’ Coverage Committee and chair of neurological surgery at University of Chicago Medicine. He said the change should reduce denials, appeals and peer-to-peer delays for patients who need the graft option.
“What made this revision meaningful was in going back to the primary literature, the safety and efficacy picture for rhBMP-2 has matured considerably since the original recommendation, and payer policies had not kept pace with the evidence,” Dr. Bydon said.
Dr. Bydon said the revised guidance should translate into faster patient access to a graft option that, used correctly, can improve fusion rates and reduce donor-site morbidity tied to autograft harvesting.
NASS’ coverage documents are used by government agencies, third-party payers, utilization management groups, spine care providers and patients nationwide. The nearly 8,000-member multidisciplinary organization spans orthopedic surgery, neurosurgery, physiatry, radiology, anesthesiology, research and physical therapy.
NASS maintains and updates coverage guidance for more than 30 spine care procedures, treatments and diagnostics.
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