Cigna modified MM 0552 for stem cell therapy in orthopaedic applications, effective December 16, 2025. Every CPT code under this policy is designated not medically necessary — and your billing team needs to act before claims go out the door.
Cigna Healthcare updated its stem cell therapy coverage policy under MM 0552 to address mesenchymal stem cell (MSC) treatments for musculoskeletal conditions. The seven affected codes — 0565T, 0566T, 0717T, 0718T, 20999, 38230, and 38232 — are all classified as not medically necessary. If your orthopaedic, sports medicine, or regenerative medicine practice bills any of these codes to Cigna, this policy update directly threatens your reimbursement.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Stem Cell Therapy for Orthopaedic Applications |
| Policy Code | MM 0552 |
| Change Type | Modified |
| Effective Date | December 16, 2025 |
| Impact Level | High |
| Specialties Affected | Orthopaedic surgery, sports medicine, pain management, regenerative medicine |
| Key Action | Audit your charge capture for CPT 0565T, 0566T, 0717T, 0718T, 20999, 38230, and 38232 before billing Cigna patients after December 16, 2025 |
Cigna Stem Cell Therapy Coverage Criteria and Medical Necessity Requirements 2025
The Cigna stem cell therapy coverage policy under MM 0552 draws a hard line. Mesenchymal stem cell therapy for orthopaedic applications is not covered. Full stop.
Cigna classifies regenerative therapy as a field of medicine still under development. That framing is the basis for the not medically necessary designation across every code in this policy.
The policy defines "stem cell therapy" narrowly for its purposes. It covers MSCs derived from bone marrow, fat tissue (adipose), amniotic membrane, and synovial blood and membrane. If your providers use any of those sources for orthopaedic regeneration — knee cartilage, rotator cuff repair, general musculoskeletal tissue — you are in scope.
Because Cigna designates all procedures under MM 0552 as not medically necessary, there is no coverage to authorize. As a billing inference: prior authorization approval — if a provider or patient obtains one through some pre-service process — does not override a not medically necessary designation. A coverage determination is not the same as a prior auth review. Don't let your team or your patients conflate the two.
One boundary the policy sets clearly: stem cell transplantation for blood cancers, non-cancer blood conditions, and solid tumors is out of scope for MM 0552. That work lives under different Cigna policies. Don't mix those cases into this review.
Cigna also points billing teams to Medical Coverage Policy 0118 — Bone, Cartilage and Ligament Graft Substitutes — for related procedures not addressed in MM 0552. If your team bills graft substitute procedures, pull Policy 0118 separately and review it alongside this one.
Cigna Stem Cell Therapy Exclusions and Non-Covered Indications
This is the part that should concern your revenue cycle team most. Every single CPT code in MM 0552 carries the same designation: not medically necessary. There are no tiered exclusions here, no covered subsets, no plan-level carve-outs listed.
Autologous cellular implants derived from adipose tissue for knee osteoarthritis — billed under 0565T and 0566T — are not covered. These codes represent the preparation and implantation components of the same procedure. Cigna denies both.
Autologous adipose-derived regenerative cell therapy for partial thickness rotator cuff tears — billed under 0717T and 0718T — is not covered. Again, preparation and implantation are both denied.
Bone marrow harvesting for transplantation, whether allogeneic (CPT 38230) or autologous (CPT 38232), falls under the not medically necessary designation when billed for orthopaedic regenerative applications under this policy. These are established CPT codes with legitimate uses in oncology — but under MM 0552's orthopaedic scope, Cigna denies them.
Unlisted musculoskeletal procedure code 20999 is also designated not medically necessary. If your team has been using 20999 to bill stem cell therapies that don't map to a Category I or Category III code, expect denial on Cigna claims.
The practical reality is straightforward and a little blunt: this policy exists to deny, not to guide appropriate billing. Cigna isn't leaving a door open here.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Knee osteoarthritis — autologous adipose-derived cellular implant (preparation) | Not Medically Necessary | 0565T | No coverage pathway; claim denial expected |
| Knee osteoarthritis — autologous adipose-derived cellular implant (implantation) | Not Medically Necessary | 0566T | No coverage pathway; claim denial expected |
| Partial thickness rotator cuff tear — ADRC therapy (preparation) | Not Medically Necessary | 0717T | No coverage pathway; claim denial expected |
| Partial thickness rotator cuff tear — ADRC therapy (implantation) | Not Medically Necessary | 0718T | No coverage pathway; claim denial expected |
| General musculoskeletal — unlisted stem cell procedure | Not Medically Necessary | 20999 | Catch-all denial; no approved alternative pathway listed |
| Bone marrow harvesting — allogeneic (orthopaedic context) | Not Medically Necessary | 38230 | Covered under oncology policies; not under MM 0552 |
| Bone marrow harvesting — autologous (orthopaedic context) | Not Medically Necessary | 38232 | Covered under oncology policies; not under MM 0552 |
Cigna Stem Cell Therapy Billing Guidelines and Action Items 2025
This policy is high-exposure for any practice offering regenerative orthopaedic treatments. Here are the steps your billing team should take before and after the effective date of December 16, 2025.
| # | Action Item |
|---|---|
| 1 | Audit your charge master for CPT 0565T, 0566T, 0717T, 0718T, 20999, 38230, and 38232 immediately. Flag every Cigna patient encounter that includes these codes. If claims haven't posted yet, hold them for review before submission. |
| 2 | Pull any outstanding claims billed to Cigna after December 16, 2025 using these codes. If they're already out, track them for denial. Set up a denial bucket specifically for MM 0552 rejections so you can measure scope and decide on appeal strategy. |
| 3 | Do not assume prior authorization approval equals coverage. Cigna designates these services as not medically necessary. A prior auth review and a coverage determination are different processes. If a provider or patient obtained some form of pre-service review and interpreted it as approval, that does not override the not medically necessary designation. |
| 4 | Update your patient financial responsibility process for Cigna patients seeking these services. Since Cigna denies these as not medically necessary, advance beneficiary notice equivalents — or in-network patient acknowledgment forms — are worth reviewing with your compliance officer. Patients who want these services as self-pay need clear documentation before treatment begins. |
| 5 | Separate your oncology bone marrow harvesting claims from your orthopaedic ones. CPT 38230 and 38232 have legitimate covered uses under Cigna's oncology policies. MM 0552 only governs the orthopaedic context. Make sure your documentation clearly reflects the clinical indication so oncology claims don't get swept into MM 0552 denials. |
| 6 | Check Cigna Medical Coverage Policy 0118 if you bill graft substitute procedures. Cigna's MM 0552 explicitly cross-references Policy 0118 for bone, cartilage, and ligament graft substitutes. If those procedures are in your mix, review 0118 separately — it may have different criteria and coverage rules. |
| 7 | Talk to your compliance officer if your practice markets stem cell therapy as covered under Cigna. Patient-facing materials, referral scripts, or scheduling workflows that describe these services as insurance-covered need to be corrected before December 16, 2025. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Stem Cell Therapy Under MM 0552
Not Medically Necessary CPT Codes
All codes listed under MM 0552 carry a not medically necessary designation. There are no covered codes in this policy.
| Code | Type | Description | Coverage Status |
|---|---|---|---|
| 0565T | CPT (Category III) | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knee; preparation of implant | Not Medically Necessary |
| 0566T | CPT (Category III) | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knee; implantation | Not Medically Necessary |
| 0717T | CPT (Category III) | Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; preparation of ADRC | Not Medically Necessary |
| 0718T | CPT (Category III) | Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; implantation | Not Medically Necessary |
| 20999 | CPT | Unlisted procedure, musculoskeletal system, general | Not Medically Necessary |
| 38230 | CPT | Bone marrow harvesting for transplantation; allogeneic | Not Medically Necessary (orthopaedic context under MM 0552) |
| 38232 | CPT | Bone marrow harvesting for transplantation; autologous | Not Medically Necessary (orthopaedic context under MM 0552) |
Note on ICD-10-CM codes: MM 0552 does not list specific ICD-10 diagnosis codes. The not medically necessary designation applies to the procedures themselves — the denial is procedure-driven, not diagnosis-driven.
The Bigger Picture on Stem Cell Therapy Billing
This policy is consistent with how major payers are treating regenerative orthopaedic medicine right now. Cigna classifies this as a field of medicine still under development — and that designation drives every denial in MM 0552. Until the evidence base shifts that classification, expect the same outcome on every claim.
The real risk for billing teams isn't a single denied claim. It's the practice that has built revenue around these services, assumes some payer coverage exists, and hasn't done a payer-by-payer audit. If stem cell therapy billing is a meaningful part of your Cigna revenue, this policy is a five-alarm signal to reassess.
Cigna stem cell therapy reimbursement under MM 0552 is effectively zero. Plan accordingly, communicate that to your clinical team, and get your patient-facing billing guidelines updated before December 16, 2025.
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