Hype, Promise, and Reality Orthopedic Use of Biologics (2021 Annual Meeting)-Hype, Promise, and Reality_ Orthopedic Use of Biologics in 2021'-McIntyre

Hype, Promise, and Reality_ Orthopedic Use of Biologics in 2021'-McIntyre

Video Transcription

Video Summary

The discussion focuses on the growing use of orthobiologics like hyaluronic acid, steroids, PRP, BMAC, and adipose tissue to treat osteoarthritis, emphasizing the ethical and transparent incorporation of these treatments into practice. The orthobiologics market is large—estimated between $4.5 to $10 billion—with strong growth and significant patient demand for alternatives to joint replacement. Billing and coding are complex, varying by payer type, setting (office vs. operating room), and procedure. Coverage is carrier-dependent; Medicare typically does not cover most orthobiologic injections, requiring Advanced Beneficiary Notifications (ABNs) to inform patients about non-coverage and out-of-pocket costs. PRP has a tracking code but no reimbursement, while BMAC and adipose injections lack specific codes and rely on unlisted procedure codes. Practices are encouraged to treat orthobiologic therapies as a distinct service line, remain compliant with evolving regulations (especially FDA rules), obtain informed consent, track outcomes, avoid calling treatments “stem cell therapy,” and educate patients responsibly.

Asset Caption

Dr. Louis F. McIntyre

Keywords

orthobiologics

osteoarthritis treatment

billing and coding

insurance coverage

patient education