Does Medicare Cover Stem Cell Injections?
- While many stem cell treatments are still experimental, Medicare may cover FDA-approved treatments deemed medically necessary. Here's what you need to know.
While research is still growing rapidly, many treatments that use stem cell injections aren’t yet approved by the FDA. Medicare does cover FDA-approved stem cell injections for specific treatments, such as certain types of cancer or diseases such as sickle cell.
Stem cells are the cells from which all other cells in your body are generated. These cells go on to form new stem cells, or they become precursors to forming specialized cells, such as bone, brain or blood cells. No other cell in the human body has the ability to generate these new specialized cells.
Current FDA-approved stem cell treatments include hematopoietic stem cell transplants, which aid in the growth of new blood cells. These treatments are often used to treat certain types of cancers, blood disorders and immune system disorders.
Which Stem Cell Therapies Are Covered by Medicare?
Stem cell treatments are still being researched, and many of these treatments are still experimental, but Medicare does cover two kinds of stem cell therapies: allogeneic stem cell transplantations and autologous stem cell transplantation. The only FDA-approved treatments using these transplantations are for:
- Some cancers
- Blood disorders
- Immune system disorders
Allogeneic stem cell transplantation is the intravenous infusion of stem cells from a healthy donor. This therapy is used to treat underlying conditions that impact your body’s ability to form new blood cells, and they’re usually used in treatments for sickle cell disease, leukemia and myelofibrosis.
Autologous stem cell transplantation involves using your own stem cells that were previously stored. This treatment is usually recommended for individuals with cancers that require radiation or chemotherapy treatments that may harm or destroy cells needed for blood production. Autologous transplantation is used to treat non-Hodgkin’s lymphoma, amyloidosis and recurrent neuroblastoma.
Medicare coverage of stem cell therapies depends on the specific treatments and how you’re receiving them. Approved injections are covered by Medicare Part A and Medicare Part B.
Medicare Part A covers inpatient treatments, hospital stays and, in some cases, skilled nursing care. During an inpatient hospital stay, if your doctor deems stem cell therapy necessary, Medicare Part A may cover the treatment.
Medicare Part B covers outpatient procedures and treatments, which could also cover stem cell therapies. In the event that your doctor deems the treatments medically necessary, Medicare will pay 80% of the costs for approved treatments.
Does Medicare Pay for Stem Cell Injections for Arthritis?
Currently, there are no FDA-approved stem cell treatments for arthritis, so Medicare won’t cover any stem cell treatments for the disease, and you’ll be responsible for the costs. There are, however, other treatments for arthritis that Medicare does cover.
What Are the Negative Effects of Stem Cell Therapy?
Many medical treatments and therapies have negative side effects associated with them. Stem cell therapy injections are no different, though many of the negative side effects are associated with experimental treatments. These side effects include:
- Reactions at the administration site
- Cells moving from the injection site and changing into inappropriate cells
- The growth of tumors
How Much Does Stem Cell Therapy Cost?
Stem cell treatments are still quite expensive, but the costs vary considerably depending on the type of treatment and your overall health. The fact that many stem cell treatments are in an inpatient setting generally increases these costs.
A 2017 study looked at the medical costs of 1,562 patients who had received stem cell treatments.
The study found that the median health care cost at 100 days was $289,283 for allogeneic treatment, $253,467 for reduced-intensity allogeneic regimen cohort and $140,792 for myeloablative autologous treatment.
The mean hospital length of stay was 35.6 days for patients receiving allogeneic treatment, 26.6 days for the reduced-intensity allogeneic patients and 21.8 days for the patients receiving autologous treatment.
Does Insurance Cover Stem Cell Injections?
Some insurance companies consider most stem cell treatments experimental and won’t cover them, but most do cover therapies that are FDA-approved.
If they won’t pay for many stem cell treatments, some insurance companies may pay for medical consultations and other costs incurred from the treatments.
