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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Note History
Contractor Information
Article Information
General Information
Source Article ID
N/A
Article ID
A58790
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections
Article Type
Billing and Coding
Original Effective Date
01/23/2022
Revision Effective Date
01/23/2022
Revision Ending Date
N/A
Retirement Date
N/A
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CMS National Coverage Policy
Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Article Guidance
Article Text The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Platelet Rich Plasma Injections for Non-Wound Injections L39060. NOTE: 0232T is the HCPCS code representing platelet rich plasma injection, any site. It is Noridian's expectation that the HCPCS code P9020 (platelet rich plasma, each unit) be billed for one or more units of PRP transfused in the treatment of the conditions/coagulopathies for which it is indicated. This code MUST NOT be used to describe the injection of PRP into a specific site. The Center for Medicare and Medicaid Services (CMS) National Coverage Determination (NCD) 270.3 outlines the coverage of PRP for the treatment of certain chronic non-healing wounds. Please refer to NCD 270.3 for further information regarding coverage indications. Should PRP meet nationally covered indication as stated in NCD 270.3, HCPCS codes G0460/G0465 must be used accordingly. Do not use code 86965, Pooling of platelets or blood products for injection(s) of platelet rich plasma. Injections that utilize a kit to create the platelet rich plasma, must be billed with category III code 0232T, and according to the CPT® codebook is not a transfusion medicine service.
Response To Comments
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Coding Information
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CPT/HCPCS Codes
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Group 1
(6 Codes) >> Includes 0232T
Group 1 Paragraph The following CPT®/HCPCS codes are noncovered:
| Code | Description |
|---|---|
| 86965 | POOLING OF PLATELETS OR OTHER BLOOD PRODUCTS |
| G0460 | AUTOLOGOUS PLATELET RICH PLASMA FOR NON-DIABETIC CHRONIC WOUNDS/ULCERS, INCLUDING PHLEBOTOMY, CENTRIFUGATION, AND ALL OTHER PREPARATORY PROCEDURES, ADMINISTRATION AND DRESSINGS, PER TREATMENT |
| G0465 | AUTOLOGOUS PLATELET RICH PLASMA (PRP) FOR DIABETIC CHRONIC WOUNDS/ULCERS, USING AN FDA-CLEARED DEVICE (INCLUDES ADMINISTRATION, DRESSINGS, PHLEBOTOMY, CENTRIFUGATION, AND ALL OTHER PREPARATORY PROCEDURES, PER TREATMENT) |
| M0076 | PROLOTHERAPY |
| P9020 | PLATELET RICH PLASMA, EACH UNIT |
| 0232T | INJECTION(S), PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED |
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CPT/HCPCS Modifiers
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ICD-10-CM Codes that Support Medical Necessity
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ICD-10-CM Codes that DO NOT Support Medical Necessity
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ICD-10-PCS Codes
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Group 1 Paragraph N/A
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Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typicallyused to report this service. Absence of a Bill Type does not guarantee that thearticle does not apply to that Bill Type. Complete absence of all Bill Types indicatesthat coverage is not influenced by Bill Type and the article should be assumed toapply equally to all claims.
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Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under otherRevenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicatesthat coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
| Code | Description |
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Other Coding Information
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Group 1 Paragraph N/A
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Coding Table Information
Excluded CPT/HCPCS Codes - Table Format
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|---|---|---|---|---|
| N/A | N/A |
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
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Revision History Information
| Revision History Date | Revision History Number | Revision History Explanation |
|---|---|---|
| 01/23/2022 | R1 | Revisions to the Article text were made. In Group I CPT code G0465 was added and 0481T was removed. |
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Associated Documents
Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L39060 - Platelet Rich Plasma Injections for Non-Wound Injections
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
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Other URLs
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Public Versions
| Updated On | Effective Dates | Status | |
|---|---|---|---|
| 11/14/2023 | 01/23/2022 - N/A | Currently in Effect | View |
| 03/30/2022 | 01/23/2022 - N/A | Superseded | You are here |
| 12/03/2021 | 01/23/2022 - N/A | Superseded | View |
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