# Prp - covered by insurances



## werner03 (Oct 20, 2012)

I am looking for some advise on PRP.  I know it is not covered by insurances and has a temporary cpt code.  I have a DPM who has found a way to do them and a very low cost to him and wants the insurance billed for the nerve block and guided ultrasound.   My auditing hat tells me that if an insurance ever looked at this and saw the visit was for a PRP injection that they would pull back any money for that day since it related to that.  Am I thinking on the right track?

Thanks,

Katie


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## mitchellde (Oct 20, 2012)

A category III code does exist for PRP injections and yes it temporary, but the reason it is temporary is to assess this procedure and determine if it is viable as a permanent level 1 CPT code.  You absolutely cannot substitute other codes when a code exists for the procedure you have performed.  You will need to have the patient sign the waiver, and bill the patient for those payers that deem this procedure non covered.


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## werner03 (Oct 21, 2012)

That I know is diffidently a no-no, but my question is billing the other services that are being done that day when the purpose of the visit is for PRP, that is my issues that I am having that I do not think the entire visit is billable!!  That is my thinking!

thanks,

Katie Werner, CPC, CPMA


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## mitchellde (Oct 21, 2012)

Since the other service is all part of the T code I do not think you should try to bill any part of it using other codes.  I say when the purpose is for the PRP and they payer has a policy stating it is non covered then the entire visit is billed to the patient.


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## werner03 (Oct 23, 2012)

yes that is what I thought and just wanted some clarification.

Thanks,

Katie Werner, CPC CPMA


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