G0460, Autologous platelet rich plasma or other blood-derived product for non-diabetic
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Documentation Required
- Billing, coding, and supporting documentation requirements are provided as a complement to LCD L39023; claims must include the documentation required by LCD L39023.
- Follow the Local Coverage Determination L39058 and CMS NCD 270.3 for clinical indications and supporting documentation to justify PRP use and appropriate code selection.
- When billing P9020, document the number of PRP units transfused (bill one or more P9020 units equal to units transfused); when billing 0232T, document that a kit was used to prepare PRP and that the service is an injection.
- The submitted medical record must support the use of the selected ICD-10-CM code(s).
- The submitted CPT/HCPCS code must accurately describe the service performed.
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Key Coverage Criteria
- Refer to Local Coverage Determination L39023 for covered indications for platelet-rich plasma (PRP) injections for non-wound indications.
- Platelet-rich plasma (PRP) used for treatment of chronic non-healing wounds is covered when it meets CMS National Coverage Determination (NCD) 270.3; bill using HCPCS G0460/G0465 accordingly.
- HCPCS P9020 should be billed for one or more units of PRP transfused when used to treat conditions or coagulopathies for which PRP transfusion is indicated.
- Platelet-rich plasma (PRP) is covered only when the service meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L39068.
- When billing for G0465 (blood-derived products for chronic non-healing wounds), coverage follows National Coverage Determination (NCD) 270.3 and must meet that NCD's criteria.
- Coverage for platelet-rich plasma (PRP) is determined by Local Coverage Determination L39071; PRP is covered only when reasonable and necessary per that LCD.
17 Active Policies
CGS-L39023, Platelet Rich Plasma Injections for Non-Wound Injections
J15
A58810, Billing and Coding: Platelet Rich Plasma
J9
FIRST_COAST-L39071, Platelet Rich Plasma
J9
NORIDIAN-L39058, Platelet Rich Plasma Injections for Non-Wound Injections
JF
NOVITAS-L39068, Platelet Rich Plasma
JH
A58808, Billing and Coding: Platelet Rich Plasma
JL
ANTHEM-MP-B094276, TRANS.00035 Therapeutic use of Stem Cells, Blood and Bone Marrow Products
AETNA-CPB-0602, Intradiscal Procedures
UMR-POL-UMR-prolotherapy-platelet-rich-plasma-therapies, Prolotherapy and Platelet Rich Plasma Therapies
SUREST-POL-SUREST-prolotherapy-platelet-rich-plasma-therapies, Prolotherapy and Platelet Rich Plasma Therapies
UHCMA-POL-UHC_MA-platelet-rich-plasma-therapies, Platelet Rich Plasma Therapies
AETNA-CPB-0005, Septoplasty and Rhinoplasty
ANTHEM-MED.00110, MED.00110 Silver-based Products for Wound and Soft Tissue Applications
A58737, Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections
A58788, Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections
UHC-POL-prolotherapy-platelet-rich-plasma-therapies, Prolotherapy and Platelet Rich Plasma Therapies
AETNA-CPB-0784, Blood and Adipose Tissue Derived Products for Selected Indications
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