The graft comes out of your DRG, not the insurer’s

Inpatient, no graft is separately reimbursed. You absorb the graft and you absorb the nonunion. Here is the ACTIFUSE case in your numbers, not ours.

What a nonunion costs

$32,303
2-YEAR COST, PSEUDARTHROSIS AFTER LUMBAR FUSION
$32,915
MEAN 2-YEAR DIRECT COST, REVISION LUMBAR FUSION
~20%
OF INSTRUMENTED FUSIONS DO NOT UNITE
10-30 cases
ONE AVOIDED NONUNION COVERS THE GRAFT ACROSS
COVERAGE, STATED STRAIGHT

One major payer names us favourably. Two do not.

Humana covers calcium phosphate ceramics and names ACTIFUSE, while excluding beta-TCP and bioactive glass. UnitedHealthcare calls all ceramics unproven. Aetna calls ACTIFUSE experimental. Anyone selling you a coverage advantage is quoting one policy and hiding two.

It matters less than it looks: inpatient, everything is bundled anyway, and UHC’s favourable InFUSE lane is the narrow on-label one while roughly 85% of real BMP-2 use sits outside it. The decision is what it always was: your cost, your nonunion risk, your call.

THE EVIDENCE FOR YOUR CLINICAL REVIEWER

93% pooled fusion, equivalence to rhBMP-2, caveats included

Cottrill 2020, Johns Hopkins, independent, 694 patients: 93% fusion, no significant difference vs rhBMP-2, standalone equivalent to mixed. Coughlan 2018, randomized, Baxter funded and disclosed: equivalent fusion, lower back-pain scores, significant at six months.

What it does not show: superiority to rhBMP-2 or other synthetics. The pooled data is heterogeneous and the authors say so. We hand your reviewer that list first, because they will find it anyway.

THE ASK

Send us your payer mix and graft spend per fusion

We return current policy pulls for your actual payers, including the ones against us, and the nonunion math on your numbers. No charge, no obligation. If it holds up, we cover the first cases in your OR and in-service your staff.

In-OR coverage, in-servicing, committee-ready evidence packets

Elite Surgical Technologies, Ohio, Michigan, Indiana and the Pittsburgh area. Rx only. ACTIFUSE is a trademark of Baxter International Inc.