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Prp - what CPT code

  1. Default Prp - what CPT code
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    Just curious to see if any docs are injecting PRP and if so what CPT code are you using to bill? What are your fees?

  2. #2
    Location
    Kansas City, MO
    Posts
    51
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    Our docs do this a fair amount, we use the new code 0232T for those done in the office. At this point we have not been paid yet but I have been told that the blues are paying other providers around $800 for this procedure, Medicare pays as well but you have to be certain to state in box 19 "medical documentation available, platelet rich plasma injection". The providers we talked to had only been reimubrsed at the trigger point allowable and Medicare had shared with them to include this info in box 19 to ensure "better" payment. It is early since the code only became effective 07/01/10, so there are a lot of appeals being sent and not a lot of data as far as who pays, who doesn't and how well they are paying.

  3. #3
    Location
    Long Island/New York
    Posts
    1,271
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    Quote Originally Posted by debwoods65 View Post
    Our docs do this a fair amount, we use the new code 0232T for those done in the office. At this point we have not been paid yet but I have been told that the blues are paying other providers around $800 for this procedure, Medicare pays as well but you have to be certain to state in box 19 "medical documentation available, platelet rich plasma injection". The providers we talked to had only been reimubrsed at the trigger point allowable and Medicare had shared with them to include this info in box 19 to ensure "better" payment. It is early since the code only became effective 07/01/10, so there are a lot of appeals being sent and not a lot of data as far as who pays, who doesn't and how well they are paying.
    I haven't heard anyone - especially Medicare - paying for PRP. Do you have an idea how much??

  4. #4
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    We have been billing it and we have had payment from our local BCBS. If its a Blues plan from outside our area we have had the PRP rep doing the appeal and getting them paid. I'm not sure dollar amounts but can let you know when I return to the office.

  5. #5
    Location
    Charleston, South Carolina
    Posts
    641
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    CMS has a non-coverage determination for PRP injections. Also, 0232T is a Category III code and has no RVU value at this time.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  6. #6
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    We charge $450 for it.

  7. #7
    Location
    Kansas City, MO
    Posts
    51
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    NYyankee - We personally have not received reimbursement from Medicare. The information I shared was given to me by other providers. What they shared was that the reimbursement they received when the billed 0232T was less than desired and that when they inquired with Medicare this was paid at the trigger point allowable. They were advised to refile their claim with the phrase "medical documentation available, platelet rich injection" in box 19 and that they should receive higher reimbursement with that. I have not heard yet what the result of that was.

    We were told that Anthem had been reimbursing at $800 for this and that it was anticipated that other blues plans would be paying as well. We have not had denials or payments yet from our local blue cross carrier so this is just info passed along at this point.

    We have received payment at this time from only one payer but I do not remember which one or exactly how much but the payment was appropriate. I can say from personal knowledge that Humana and UHC are definitely NOT paying for this so we make our patients aware before they have it done that it will become their responsibility once the ins clm is processed.

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