Does Medicare Cover Stem Cell Therapy for Knees? 

In the United States, stem cell therapies are being used to treat certain types of cancer and medical conditions. These non-invasive therapies help reduce pain, increase body movement and functionality, and reduce recovery times for patients.

In 2008, medical professionals started using autologous adult mesenchymal stem cells to boost knee cartilage regeneration. This kind of stem cell therapy is known as orthobiologic therapy, and it uses the patient’s stem cells for treatment.  

Since then, studies have shown that this type of stem cell therapy could be effective in treating knee osteoarthritis, a painful condition caused by the deterioration of cartilage that covers leg and knee bones. Orthobiologic stem cell therapy can help regenerate the damaged cartilage, reduce pain, swelling, and stiffness, and increase knee function and mobility as well. 

Unfortunately, orthobiologic therapy isn’t a recommended treatment for osteoarthritis, and it hasn’t been approved by the FDA as of now. This is mainly because research is limited, results of studies done so far are inconclusive, and there aren’t standard procedures, yet. But medical professionals aren’t giving up hope that it may be a good option in the future.  

Does Medicare cover stem cell therapy for knees? 

Medicare doesn’t cover stem cell therapy for knee arthritis because it hasn’t been approved by the FDA, as of now. However, Medicare doescover other kinds of treatments for pain and discomfort caused by osteoarthritis of the knee for those who meet the eligibility requirements. 

Medicare coverage includes the following:

• Physical therapy
• A genicular nerve block procedure that blocks the nerve supply to the knee. It’s a minimally invasive procedure that takes 10 to 15 minutes, but it may require sedation.  
• Hyaluronic acid gel injections if you have knee osteoarthritis showing on X-rays

To be eligible for Medicare coverage of these treatments, you must:

• Be enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance), or a Medicare Advantage (Part C) plan 
• Have written certification from your health care provider that the procedure is medically necessary to treat your condition, and that other types of treatments haven’t been successful. 
• Have the procedure done by a physician that accepts Medicare assignment and in a medical facility that accepts Medicare assignment. If you have Part C coverage, you may need to use in-network providers for your care. 

If you’re enrolled in Original Medicare Part B and qualify for this benefit, Medicare pays 80 percent of the final approved cost of the procedure. You must pay the remaining 20 percent after meeting your annual Part B deductible. 

If you’re enrolled in a Medicare Advantage (Part C) plan, your out-of-pocket cost for covered procedures depends on what type of plan you have and how much your provider charges for coinsurance. You should contact your provider for details if you aren’t sure what your coverage includes, or whether you have any network restrictions. 

Knee replacement surgery

Medicare also covers knee replacement surgery if you have tried other types of treatment with no relief, and your physician certifies that it is medically necessary. 

Knee replacement might be medically necessary if any of the following issues are true for you:

• Some of your leg bones contain fractures.
• You have malignant tumors or dead tissue in the knee area.
• You have a previous knee replacement that has failed.
• You have advanced knee joint disease that hasn’t benefited from other types of treatment like those listed above. 

If you’re enrolled in Original Medicare, your coverage depends on where you have your knee replacement surgery. 

Medicare Part A covers the cost if you have the procedure done as an inpatient in a hospital that accepts Medicare assignment. You must pay the Part A deductible for the current benefit period before Medicare covers its share of the expenses. 

Medicare Part B covers its share of the cost if you have the procedure (known as rapid recovery knee replacement) done as an outpatient in a medical facility that accepts Medicare assignment. Part B pays 80 percent of the cost, and you pay 20 percent after paying your annual deductible.