Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J15 · Effective Dec 10, 2023
18 active Medicare policies list Q4189, and 14 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J15 · Effective Dec 10, 2023
J5 · Effective Nov 12, 2023
J8 · Effective Nov 12, 2023
J9 · Effective Dec 1, 2024
J6 · Effective Dec 24, 2023
JK · Effective Dec 24, 2023
JE · Effective Nov 12, 2023
JF · Effective Nov 12, 2023
14 policies from 9 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Amniotic Membrane and Amniotic Fluid | Dec 15, 2025 | Covered |
| Bioengineered Skin and Soft Tissue Substitutes | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Amniotic Membrane and Amniotic Fluid | Dec 15, 2025 | Covered |
| Bioengineered Skin and Soft Tissue Substitutes | Jul 1, 2026 | Covered |
JH · Effective Dec 1, 2024
JL · Effective Dec 1, 2024
JJ · Effective Apr 30, 2023
JM · Effective Apr 30, 2023
National · Effective Oct 23, 2025
J6 · Effective Oct 1, 2025
National · Effective Oct 1, 2025
J5 · Effective Oct 1, 2025
J9 · Effective Jan 1, 2026
JL · Effective Jan 1, 2026
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Amniotic Membrane and Amniotic Fluid | Dec 15, 2025 | Covered |
| Bioengineered Skin and Soft Tissue Substitutes | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Amniotic Membrane and Amniotic Fluid | Dec 15, 2025 | Covered |
| Bioengineered Skin and Soft Tissue Substitutes | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Cigna Commercial Other Services Code List - Effective 03/07/2026 | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List - Effective 03/07/2026 | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Skin and Soft Tissue Substitutes | Not recorded | Covered |
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Skin and Tissue Substitutes | May 25, 2026 | Covered |
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Skin and Soft Tissue Substitutes | Jun 1, 2026 | Covered |
| Policy | Effective | Status of Q4189 |
|---|---|---|
| Skin and Soft Tissue Substitutes | Jun 1, 2026 | Covered |