Billing and Coding: Platelet Rich Plasma

Coverage for platelet-rich plasma (PRP) is limited to services that meet the reasonable and necessary criteria in LCD L39068, and billing for G0465 must follow NCD 270.3 for blood-derived products used in chronic non-healing wounds. Services not meeting those determinations should not be billed as covered (use an appropriate modifier for non-covered services), and PRP services outside NCD 270.3 guidelines will be denied. All medical records must be legible, include patient identification and provider signature, and must support the ICD-10-CM and CPT/HCPCS codes billed.

"Platelet-rich plasma (PRP) is covered only when the service meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L39068."

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