PRP for Arizona Work Comp

carlyjo82

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Can anyone help me with what codes to bill to ICA for a PRP injection? This would be something that would be pre authorized by the adjuster. If we bill 0232T, it is paid off the fee schedule which is only $72.00 and that doesn't even cover the physician's cost for the PRP kit. I know in the past we used to bill the tissue grafts and platelet apheresis, but this is no longer appropriate. Does anyone know what the code(s) are to get proper reimbursement for a true PRP from ICA? Any help would be appreciated! Thank you!
 
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I can't find any other code other than what you have. Are you certain it's paid off fee schedule? I tried to find where it listed the reimbursement as $72.00 and couldn't find it anywhere.
 

carlyjo82

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I can't find a fee schedule that lists that either. I do believe that PRP was approved for specific procedures/body areas, and the fee amount was $72.00. I had heard that a while back. But I can't find it anywhere either. My practice does a lot of work comp PRP's, so I'm just trying to see if there are codes that are appropriate other than 0232T.
 
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I think the reimbursement is dependent on the documentation. I could not find any alternative code, but I found a bunch of information (relevant only to California) where it's been appealed I don't know how many times to their state Dept of Labor/Work Comp because of low reimbursement. I couldn't find one appeal that was in favor of any WC payer. Unfortunately in this situation, it's Arizona's Dept of Labor doing the pricing...
 
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