LCDActive
Platelet Rich Plasma
L39071
First Coast Service Options, Inc. (J09)
Effective: December 12, 2021
Updated: December 31, 2025
Policy Summary
Platelet-rich plasma (PRP) injections/applications are covered only when they meet the requirements of NCD 270.3 for blood-derived products used to treat chronic non-healing wounds. Any PRP use outside NCD 270.3 is considered not medically reasonable and necessary and therefore non-covered. Compliance may be monitored via post-payment data analysis and medical review audits.
Coverage Criteria Preview
Key requirements from the full policy
"Platelet-rich plasma (PRP) injections and/or applications are covered only when the use complies with National Coverage Determination (NCD) 270."
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