LCD Reference ArticleBilling and Coding Article
A58282
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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.
Document Note
Note History
Contractor Information
Article Information
General Information
Source Article ID
N/A
Article ID
A58282
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Platelet Rich Plasma
Article Type
Billing and Coding
Original Effective Date
02/07/2021
Revision Effective Date
07/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
CPT codes, descriptions, and other data only are copyright 2023 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 notrecommending 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. Current Dental Terminology © 2023 American Dental Association. All rights reserved. Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission.No portion of the AHA copyrighted materials contained within this publication may becopied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes anddescriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative workwithout the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes,resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions;and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyauthorized with an express license from the American Hospital Association.The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness oraccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in thepreparation of this material, or the analysis of information provided in the material. The views and/or positionspresented in the material do not necessarily represent the views of the AHA. CMS and its products and services arenot endorsed by the AHA or any of its affiliates.
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.
Response To Comments
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Coding Information
Bill Type Codes
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Revenue Codes
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CPT/HCPCS Codes
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Group 1
(5 Codes)
Group 1 Paragraph The following CPT®/HCPCS codes are noncovered:
Code | Description |
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G0465 | AUTOLOGOUS PLATELET RICH PLASMA (PRP) OR OTHER BLOOD-DERIVED PRODUCT FOR DIABETIC CHRONIC WOUNDS/ULCERS, USING AN FDA-CLEARED DEVICE FOR THIS INDICATION, (INCLUDES AS APPLICABLE ADMINISTRATION, DRESSINGS, PHLEBOTOMY, CENTRIFUGATION OR MIXING, 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 |
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CPT/HCPCS Modifiers
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Group 1
Group 1 Paragraph N/A
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ICD-10-CM Codes that Support Medical Necessity
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Group 1 Paragraph N/A
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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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Additional ICD-10 Information
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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.
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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 |
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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 |
---|---|---|
07/01/2023 | R3 | Under CPT/HCPCS Codes Group 1: Codes the descriptor was revised for G0465. This revision is due to the 2023 Q3 CPT/HCPCS update and is effective on 7/1/23. |
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. |
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Associated Documents
Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
Articles
DA58808 - Billing and Coding: Platelet Rich Plasma (MCD Archive Site)
DA58810 - Billing and Coding: Platelet Rich Plasma (MCD Archive Site)
LCDs
L38745 - Platelet Rich Plasma
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 | |
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06/19/2023 | 07/01/2023 - N/A | Currently in Effect | You are here |
Some older versions have been archived. Please visit theMCD Archive Site to retrieve them. |
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