S9055 — Procuren or other growth factor preparation to promote wound healing
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.
- 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
- 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.
- Services billed under HCPCS G0465 (blood-derived products for chronic non-healing wounds) are subject to National Coverage Determination 270.3 and coverage follows NCD 270.3 rules.
- Platelet-rich plasma (PRP) injections and/or applications are covered only when used in accordance with NCD 270.3 (Blood-Derived Products) for treatment of chronic non-healing wounds.
- Platelet-rich plasma (PRP) injections and/or applications are covered only when the use complies with National Coverage Determination (NCD) 270.3 for blood-derived products for chronic non-healing wounds.
12 Active Policies
A58810 — Billing and Coding: Platelet Rich Plasma
J09
L39071 — Platelet Rich Plasma
J09
A58808 — Billing and Coding: Platelet Rich Plasma
J12
L39068 — Platelet Rich Plasma
J12
AETNA-CPB-0784 — Blood and Adipose Product Injections for Selected Indications
Related Codes
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