SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections

A58790

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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
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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.

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Coding Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply 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 other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Coding Table Information

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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 National Coverage Documents
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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

Keywords

  • PRP