P9020 — Platelet rich plasma, each unit
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- This billing and coding guidance complements Local Coverage Determination (LCD) L38745 for Platelet Rich Plasma; refer to LCD L38745 for specific clinical indications, coverage rules, and required documentation.
- This article contains billing, coding, or guideline information that complements the LCD; specific documentation, prior authorization, or forms are not specified here and must be obtained from the LCD or payer.
- 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.
Key Coverage Criteria
- This article does not list specific covered indications; coverage is determined by the referenced Local Coverage Determination (LCD) for Platelet Rich Plasma.
- 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.
20 Active Policies
A58609 — Billing and Coding: Platelet Rich Plasma
J06
L38937 — Platelet Rich Plasma
J06
L39071 — Platelet Rich Plasma
J09
A58810 — Billing and Coding: Platelet Rich Plasma
J09
A58808 — Billing and Coding: Platelet Rich Plasma
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.