Researchers from University of Southern California Keck School of Medicine Report Details of New Studies and Findings in the Area of Cell Therapy (Commercial Insurance Payer References Do Not Substantiate Coverage Denial of Stem Cell Therapy …): Drugs and Therapies – Cell Therapy

2025 OCT 21 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- New research on Drugs and Therapies - Cell Therapy is the subject of a report. According to news reporting originating in Los Angeles, California, by NewsRx journalists, research stated, “Regenerative therapies are being studied for use in several orthopedic conditions, but as these approaches gain in popularity, insurance coverage denials have become a critical issue for patients, physicians, hospitals, and payers. We sought to analyze the references commercial payers use to support their policies denying coverage for orthopedic applications of mesenchymal stem cell (MSC) therapy.”

The news reporters obtained a quote from the research from the University of Southern California Keck School of Medicine, “We reviewed the policies regarding orthopedic applications of MSC therapy of the top 11 national commercial health insurance payers, 5 of which had publicly accessible policies. Supporting references were screened by title and/or abstract. Selected references were categorized by type of reference and reviewed for level of evidence (LOE), anatomic location under investigation, and type and source of MSC. Studies that were not LOE I or II were defined as low LOE. Finally, efficacy of the therapy was recorded in a binary fashion. To support denial of coverage for MSC use in orthopedics, the 5 insurance companies cited a majority of level IV evidence, despite available and pertinent level I and II studies on the subject. The knee was the most common anatomic location investigated and, along with the spine, the most likely to report favorable outcomes with MSC use. Primary journal articles and studies with higher LOE were more likely to report favorable outcomes than review articles or those with lower LOE. This analysis of 5 commercial insurance payers’ policies found that they substantiate their denial of coverage for MSC use in orthopedic applications primarily with low-level evidence.”

According to the news reporters, the research concluded: “It also found that higher-level evidence, when cited, often points to the potential efficacy of MSCs.”

This research has been peer-reviewed.

For more information on this research see: Commercial Insurance Payer References Do Not Substantiate Coverage Denial of Stem Cell Therapy for Orthopedic Applications. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, 2025. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery can be contacted at: Sage Publications Inc, 2455 Teller Rd, Thousand Oaks, CA 91320, USA.

Our news correspondents report that additional information may be obtained by contacting Cailan L. Feingold, University of Southern California Keck School of Medicine Usc, Los Angeles, CA 90033, United States. Additional authors for this research include Jacob L. Kotlier, Amir Fathi, Meng-Yung Ong, Benjamin M. Lurie, Ryan D. Freshman, Cory K. Mayfield, Frank A. Petrigliano and Joseph N. Liu.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1177/15563316251357013. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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