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CPT 20939 Bone marrow aspiration for bone grafting, spine surgeryLast reviewed at VbBS in November 2017. Minutes indicate that the staff recommendation was accepted without significant discussion. HERC approved the recommendations without change. Bone marrow aspirate for spinal fusionCode: 20939 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incisionBackground: Iliac crest bone harvest has been considered the “gold standard” at producing successful arthrodesis of the lumbar spine but is also associated with many donor-site morbidities. There has been investigative work on using many alternative types of materials to aid fusion, including bone marrow or stem cells.Similar codes:Previously, 38220 (Bone marrow; aspiration only) was the only code available for this procedure. This code is diagnostic.20937 (Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision)) is on lines 51,154,205,259,351,366,406,482, 532, 561EvidenceKhashan 2013, systematic review of alternative fusion materials for spinal surgeryKQ1: Does the use of bone marrow aspirate (BMA) combined with synthetic or allograft extenders contribute to thoracolumbar fusion rates that are comparable with the rates achieved by the use of iliac crest graft? 4 level II, III studies used iliac crest bone graft as control. The results of these studies were inconsistent, and the overall body of evidence was found insufficient.KQ2: Are these fusion rates comparable with those of local bone graft (LBG)?Three, level II, III studies were identified for KQ2. Comparable fusion rates were demonstrated between LBG and BMA combined with calcium phosphate or collagen carrier. The overall body of evidence was found to be weak.KQ3: Does the addition of MSCs or BMA to iliac crest bone graft or LBG contribute to better throracolumbar fusion rates? For KQ3, one level III study was found. No significant difference was found in the fusion rates.KQ4: Are the cervical spine fusion outcomes achieved by the use of SCM or BMA with synthetic or allograft scaffolds comparable with the iliac crest bone graft or LBG outcomes? No studies met the criteria for KQ4KQ5: Was there any difference in terms of fusion rates, when MSCs were compared with BMA? No studies met the criteria for KQ5Conclusion. The currently available evidence is insufficient to support the use of MSCs or BMA combined with synthetic or allograft materials as a substitute or supplementary graft to autologous bone graft.Other policies:Aetna considers bone marrow aspiration for spinal fusion experimentalCigna does not appear to cover bone marrow aspiration for spinal fusionAnthem covers bone marrow aspiration for spinal fusion when used with particular substratesHERC staff summary: bone marrow aspirate for spinal fusion appears to be experimental. Alternative fusion techniques, such as use of iliac crest bone, are available and have good reported outcomes.HERC staff recommendations:Add 20939 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision to line 660 CONDITIONS FOR WHICH CERTAIN TREATMENTS HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS; unproven treatments with an entry for GN173 as shown belowGUIDELINE NOTE 173, TREATMENTS THAT HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS FOR CERTAIN CONDITIONS; unproven treatmentsThe following treatments are prioritized on Line 660, CONDITIONS FOR WHICH CERTAIN TREATMENTS HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS; unproven treatments for the conditions listed here:CPT/HCPCS codeINTERVENTIONRationaleDate of last Review20939Bone marrow aspiration for bone grafting, spine surgeryUnproven treatmentNovember, 2017 ................
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