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Protein Rich Plasma

  1. #1
    Long Island/New York
    Default Protein Rich Plasma
    Medical Coding Books
    I need some imput on PRP for orthopedic surgeries. I know it's an unlisted procedure but I've been asked to look into CPT code 20926 - not for RVU but to submit. I don't think it will work but has anyone else tried to bill out this procedure with any other code than the unlisted.

    You have to understand, ALL of my Dr's hate unlisted codes and want to find new ways to code. I won't even tell you about FAI's that some CPT codes my Dr's think they should use.


  2. #2
    North Carolina
    We had one physician that performed this service and 20926 was the recommended code. Unfortunatley, the carrier did not pay for this. Then, it was recommended to use P9020. This didn't work either. I would really like to know if anyone else received reimbursement for these services.

  3. #3
    I use an unlisted and cross code with 36513

  4. #4
    That is funny because I'm sure on FAI the codes your doctors want to use probably the same as the ones mine want to use. HAHA A nightmare to say the least. As are the PRP injections

  5. #5
    This was just posted in the March 2009 CPT Assistant:

    "Question: During an orthopedic procedure, the patient's blood was drawn and then centrifuged to separate the platelet-rich plasma from the platelet-poor plasma. The red cells were injected into the operative site. Is it appropriate to report code 36513, Therapeutic apheresis; for platelets, for the procedure performed to obtain the platelets?

    Answer: No. To obtain the cells for injection, code 86999, Unlisted transfusion medicine procedure, should be reported when for example, intraoperatively, 60 ccscc's of blood are drawn from the patient, centrifuged for 15 minutes to separate the platelet-rich plasma (fibrin) from the platelet-poor plasma and red cells, and injected into the operative site. It is not appropriate to report code 36513 as therapeutic apheresis was not performed.

    The placement/injection of the cells into the operative site is an inclusive component of the operative procedure performed and not separately reported, and would be considered an inclusive component of the operative procedure performed. "

  6. #6
    Question plasma pheresis
    Is anyone getting paid for this service? I have a physician trying to bill 20551, 36514, 20999 for a platelet rich plasma injection into th elbow for epicondylitis.

  7. #7
    Smile Protein rich plasma injections
    Our physician wants to do a plasma rich protein injection in the foot. I have been told to use 20550. Is this correct? I've also heard they are coming out with a new code July 1, 2010, has anyone heard of this b/c I can't find it anywhere.

    Thanks for your input.

  8. #8
    North Carolina
    0232T will be the new code-

    As for 20550, I would use caution. My recommendation is an unlisted code. The reason: Many carriers do not pay for PRP's (per policys/guidelines listed on their websites). If you report 20550, this will likely pay but if you're audited, the carrier will, more than likely, recoupe the payment once the discover what was actually perfomed. If you submit an unlisted code, the carrier can see,up front, what was performed and pay/deny based on the documentation. Now...if you're in a geographic region where this is paid based on carrier guidelines, that's a different story.

  9. Default
    Here is an article from 02/10 from orthopedic coders pink sheet about this subject.

    Subject PRP gets its own Category III code
    Source Coder Pink Sheets: Orthopedic
    Publication Orthopedic: Orthopedic Coder's Pink Sheet, February 2010, Vol. 11, No. 2
    Effective Date Feb 3, 2010
    Publish Date Feb 3, 2010

    If your practice performs platelet rich plasma (PRP) injections, you'll have a new Category III CPT code to report for the therapy beginning July 1.

    The AMA issued the following new code, as well as a dozen others as part of its Jan. 1 update to the Category III code list:

    0232T (injection[s], platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed).
    In a parenthetical note issued with the new code, CPT instructs you not to report 0232T with any of the following:

    tendon and tendon sheath injection (20550-20551);
    tissue graft (20926);
    imaging (76942, 77002, 77012, 77021); and
    pooling of platelets or other blood products (86965).
    The new code appears to be inclusive of all the above services. That means no additional billing of imaging or spinning of the platelets. There might be the opportunity to separately report supply code 99070 for the PRP "kit," but not to Medicare. It will be up to non-Medicare payers whether they will pay separately for the supply code.

    Note the presence of a code does not mean you are guaranteed payment for a procedure. Many payers continue to consider PRP investigational and therefore noncovered.

    Also, the presence of the new code removes any uncertainty over what code applies to PRP, so if a payer policy states 0232T is not covered, you may not report the service with an unlisted code or a different injection code.

    Practices will also need to keep an eye on CCI edits starting in July, to see whether 0232T is bundled into musculoskeletal surgical codes.

    Transforaminal epidurals with ultrasound: As it did last fall with facet joint injections, CPT has issued new Category III transforaminal epidural codes that include ultrasound guidance. These codes also were included in the Jan. 1 release. All of the following codes take effect and are available for use starting July 1:

    0228T (injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level).
    0229T (each additional level [List separately in addition to code for primary procedure]).
    0230T (injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level).
    0231T (each additional level [List separately in addition to code for primary procedure]).
    These new Category III codes are a signal CMS appears to be on track to issue new transforaminal Category I codes for next year that include fluoroscopy, as it did with the facet codes in this year's code set.

    Both the PRP and transforaminal codes are scheduled to be included in the 2011 CPT manual.

    Official resource:

    Find the AMA CPT Category III code list at:

    Hope this helps.

    Last edited by Bella Cullen; 06-11-2010 at 12:45 PM.

  10. #10
    I understand the CPT code for the plasma rich protein inejction, but where do we get the pricing info from? Medicare doesn't have any pricing info at all. Can you help with the pricing?


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