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Is PRP Covered by Insurance?

Published: 06/12/2020
Is PRP Covered by Insurance

Platelet-Rich Plasma (PRP) is used to treat a wide variety of conditions and injuries. With the cost of PRP ranging from $800 to $2000 per injection, patients look to insurance companies to help cover the treatment expenses. But, is PRP covered by insurance? Let’s find out.

What is PRP?

PRP is defined as a concentration of platelets prepared from a patient’s blood. Regenerative medicine practitioners inject PRP back into the patient to help improve their health and stimulate the healing process.

Benefits of the growth factors and other properties in PRP may include healing sports injuries, treating pain caused by osteoarthritis, and addressing wrinkles.

How much does PRP treatment cost?

Currently, the cost of PRP treatment varies, ranging from about $800-$2,000 per single PRP injection.

Your PRP therapy bill can depend on several factors, such as the certification and experience of the prp specialist performing the procedure, the geographical location in which the therapy is being performed, and the body area(s) being treated, the quality of the PRP system being used to process and capture the platelets..

Is PRP Covered by Insurance?

Oftentimes, PRP is not covered by insurance because many health insurance companies recognize PRP as an experimental treatment.

Certain insurance companies do cover PRP, though, the coverage depends on the condition or injury being treated. One such company is Tricare, which covers PRP injections for patients with tennis elbow and mild to moderate chronic knee osteoarthritis.

Patients that use the health insurance provider WellCare Health Plans may receive PRP if they sign up for a study too.

Talk with your insurance provider to learn if your current plan covers PRP, and how.

Is PRP Covered by Medicare and Medicaid?

The Centers for Medicare & Medicaid Services will only cover PRP for patients with “chronic non-healing diabetic, pressure, and/or venous wounds” that are also enrolled in a clinical research study.

How to Get Insurance Coverage for PRP

If your plan does not cover PRP, changing your insurance plan to one that does and/or signing up for a study may be an option.

Another option is to try to convince your insurance company that the therapy is not experimental. This involves gathering studies, reaching out to those that conduct the studies, and forming cost comparisons.

The Importance of Insurance Codes

Be sure to talk to your doctor and insurance provider about insurance coding systems for PRP-related treatments that affect both you and them.

For example, the CPT (Current Procedural Terminology) codes identify medical procedures and impact how much you’ll be charged for a service and how much your healthcare provider will be paid.

CPT Category III code 0232T has been used for the harvesting, preparation, and image guidance of PRP injections into any tissue. This code might not be correct if other treatments are used alongside the injections.

If you’re involved in a clinical PRP study for Medicare, that study will have a Healthcare Common Procedure Coding System (HCPCS) code of G0460, which refers to the preparation and application of autologous PRP for ulcers. HCPCS is specifically used by Medicare.

Medicare contractors will not reimburse physicians for the treatment unless there is a billable ICD-10-CM code of Z00.6 and other criteria are met. ICD codes (International Classification of Diseases) are used to identify a diagnosis, and Z00.6 refers to, “a diagnosis of encounter for examination for normal comparison and control in clinical research program.”