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PRP injections - ambulatory center

  1. #1
    Default PRP injections - ambulatory center
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    Can someone please help me with coding a PRP injection ? I was advised to use 20926 however that is an incorrect code to use. As of July 1st, it was changed to 0232T which only an ambulatory center can use per Medicare. Would it be possible to code
    36514, A4649 for surgical tray, 76942 for ultrasound, and a tenotomy code? Any advice would be appreciated.
    Has anyone gotten reimbursed for a PRP injection?

  2. #2
    I had attended a seminar with Margie Vaught, she obtained an official opinion from the AMA regarding PRP injections.

    It stated "there is no specific CPT code to described platelet rich plasma injection from the patient's blood, having been drawn and centrifuged, and injected into the anatomic site involved"

    They recommend using unlisted pathology code 89999 unlisted transfusion medicine procedure and that is the only code that should be used.

    I do not know of anyone who has gotten paid for this. I never have. I do know some docs who are doing it on a cash basis.

  3. #3
    Greeley, Colorado
    7/1/10 temporary CPT 0232T became effective for PRP however CMS, UHC, Cigna Anthem, Aetna, etc all consider it investigational and experimental so it is NOT covered. We have the patients sign a service waiver or ABN and they are responsible.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Charleston, South Carolina
    This is what it says at AMA effective 7/1/10:

    0232T Injection(s), protien rich plasma, any tissue, including image guidance, harvesting and preparation when performed.

    Do not code in conjunction with 20550, 20551, 20926, 76942, 77002, 77012, 86965.

    Also, when a Category III code exists, it is incorrect coding to use the appropriate area unlisted code per coding convention.

    0232T has no RVU value currently, so no payment value for Medicare (which does not cover it). Physcians can bill it also, but whether they get paid or not by commercial carriers is up to each carrier.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

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