Orthopedic Applications of Platelet-Rich Plasma

This policy addresses use of autologous platelet-rich plasma (PRP) and related platelet-derived products—including intraoperative platelet gel and bedside platelet separation systems—for orthopedic, periodontal, and maxillofacial procedures and as primary injection therapy for tendinopathies and other musculoskeletal conditions (e.g., lateral epicondylitis, plantar fasciitis, Achilles, rotator cuff, patellar). Coverage is limited to indications supported by current peer‑reviewed evidence and authoritative dosing recommendations, is subject to the member’s benefit plan and applicable Illinois Public Act 103‑0458 provisions, and many proposed primary injection and adjunctive uses (including several tendinopathies, osteoarthritis, ACL/rotator cuff repair, spinal fusion, and others) are considered experimental/investigational and not covered.

"Therapies are covered when proven effective for the relevant diagnosis based on current peer-reviewed scientific literature."