Local Coverage Article Billing and Coding

Billing and Coding: Platelet Rich Plasma

A58282

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Contractor Information

Article Information

General Information

Article ID
A58282
Article Title
Billing and Coding: Platelet Rich Plasma
Article Type
Billing and Coding
Original Effective Date
02/07/2021
Revision Effective Date
01/23/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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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 L38745.

Coding Information

CPT/HCPCS Codes

Group 1

(5 Codes)
Group 1 Paragraph

The following CPT®/HCPCS codes are noncovered:

Group 1 Codes
CodeDescription
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
S9055 PROCUREN OR OTHER GROWTH FACTOR PREPARATION TO PROMOTE WOUND HEALING
0232T INJECTION(S), PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED

CPT/HCPCS Modifiers

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ICD-10-CM Codes that Support Medical Necessity

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

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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Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/23/2022 R2

Under CPT/HCPCS Codes Group 1: Codes added G0465 and deleted 0481T. This revision is retroactive effective for dates of service on or after 1/23/2022.

04/13/2021 R1

Under CPT/HCPCS Codes Group 1: Codes deleted G0460. This revision is retroactive effective for dates of service on or after 4/13/21.

Associated Documents

Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
01/31/2022 01/23/2022 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • PRP