Stem Cell Therapy for Orthopaedic Applications - (0552) — MM 0552 | CIGNA Coverage Update

Cigna Healthcare modified MM 0552 for stem cell therapy in orthopaedic applications, effective December 16, 2025. Every code under this policy is designated not medically necessary — here's what billing teams need to do.

Cigna Healthcare updated coverage policy MM 0552, which governs mesenchymal stem cell (MSC) therapy for orthopaedic and musculoskeletal conditions. The revision affects seven confirmed CPT codes — 0565T, 0566T, 0717T, 0718T, 20999, 38230, and 38232 — all of which Cigna designates as not medically necessary. (The source data contains eight rows, but one entry appears to be a malformed citation rather than a valid CPT code; flag this with your source data team for verification.) If your practice bills any of these procedures for Cigna members, expect denials on and after December 16, 2025.

Quick-Reference Table

Cigna Stem Cell Therapy Coverage Criteria and Medical Necessity Requirements 2025

The Cigna stem cell therapy coverage policy MM 0552 covers a specific and narrow scope: mesenchymal stem cells (MSCs) derived from bone marrow, fat tissue (adipose), amniotic membrane, and blood and membrane in the joints for orthopaedic regenerative applications.

The policy is blunt on medical necessity. Cigna does not consider any of the stem cell procedures listed under this policy to meet the medical necessity standard for coverage. Regenerative therapy using MSCs for musculoskeletal conditions is categorized as a field still under development — and that classification drives the not medically necessary designation across every applicable code.

This is not a gray area. There are no coverage criteria to meet, and the policy does not describe any prior authorization pathway for these services. If you're billing Cigna for stem cell therapy in an orthopaedic context, you're billing into a wall.

The MM 0552 policy is also deliberately scoped. Stem cell transplantation for blood cancers, non-cancer hematologic conditions, and solid tumors falls outside this policy entirely — those services are governed by separate Cigna policies. Don't conflate CPT 38230 or 38232 (bone marrow harvesting for transplantation) when billed in an oncology context with their treatment under MM 0552. Context matters for claim routing.

Cigna also points billing teams to Medical Coverage Policy 0118 — Bone, Cartilage and Ligament Graft Substitutes — for related procedures outside this policy's scope. If your team bills graft substitutes alongside stem cell procedures, review Policy 0118 separately.

Cigna Stem Cell Therapy Exclusions and Non-Covered Indications

Every procedure in this policy falls under the not medically necessary designation. There are no covered indications. That's the whole story here, and it's worth being direct about it.

The specific procedures Cigna targets with this update are fat-tissue-derived cellular implants for knee osteoarthritis (CPT 0565T and 0566T) and adipose-derived regenerative cell (ADRC) therapy for partial-thickness rotator cuff tears (CPT 0717T and 0718T). These are the two clinical applications with the most active billing activity — and the ones most likely to generate claim denial volume.

The unlisted musculoskeletal procedure code 20999 is also explicitly named as not medically necessary under MM 0552. That tells you something. Cigna anticipated that providers might try to route stem cell procedures through an unlisted code to avoid a hard denial on a Category III code. The policy closes that door.

Bone marrow harvesting codes 38230 (allogeneic) and 38232 (autologous) are listed as not medically necessary when billed in this orthopaedic context. Again — if these codes appear in an oncology claim, that's a different policy. But in a musculoskeletal regenerative medicine context, Cigna won't cover them.

Coverage Indications at a Glance

Cigna Stem Cell Therapy Billing Guidelines and Action Items 2025

Here's what your billing team needs to do before December 16, 2025.

If you're a billing manager at a multi-specialty group with significant Cigna volume, loop in your compliance officer before the effective date. The combination of a categorical not medically necessary designation, an unlisted code closure, and active financial responsibility obligations makes this a compliance exposure if it isn't handled cleanly.

CPT, HCPCS, and ICD-10 Codes for Stem Cell Therapy Under MM 0552

Not Medically Necessary CPT Codes

All codes listed under Cigna MM 0552 carry a not medically necessary designation. There are no covered codes under this policy.

The source data contains eight rows, but one entry appears to be a malformed citation rather than a valid CPT code. The seven confirmed codes are listed below. Flag the eighth entry with your source data team for verification before relying on this policy list for charge master updates.

Note: No ICD-10-CM diagnosis codes are specified in the MM 0552 policy data. The not medically necessary designation applies at the procedure code level regardless of diagnosis.

A Note on the Broader Stem Cell Therapy Billing Picture

This policy doesn't exist in a vacuum. Cigna's position on stem cell therapy for orthopaedic applications reflects a broader payer trend toward treating MSC-based and ADRC therapies as investigational. Whether Cigna stem cell therapy reimbursement becomes available in future years depends on the clinical evidence base for these procedures. Right now, that evidence isn't there at a level Cigna is willing to act on.

The real financial risk for practices isn't just the Cigna denials themselves. It's the downstream reimbursement exposure if patient financial responsibility agreements aren't in place before service. Stem cell procedures for orthopaedic conditions can run to significant out-of-pocket costs per session. Without a signed agreement, your collections position is weak.