Wiki Help with PRP injection coding

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klamond

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Does anyone have any information regarding PRP injections. I know it should be reported with CPT code 0232T. However, I am wondering if there is a supply code we can use for the use of the machine. We rent our machine from a vendor. Patients are normally self pay for this procedure but since it is now on the Horizon and CMS fee schedule for $43.00, the cost of the machine is way more then what ins allows. Any information would be greatly appreciated.
 
Do you have any CMS links for that fee schedule and/or the private insurance please?

Peace
@_*
Thanks in advance.
 
Looking at the code description everything is included as well as the imaging guidance

daedolos said:
Do you have any CMS links for that fee schedule and/or the private insurance please?

Peace
@_*
Thanks in advance.
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It will depend on the MAC. Its a carrier priced code. I'm doing a fee schedule for Alabama right now and its still not valued.

I still don't see that its covered by CMS unless its related to a clinical trial. Remember a rate assignment doesn't guarantee coverage.
 
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Just curious as this office has had several claims from late last year concerning PRP injections. None have been paid by the private insurance.

Peace
@_*
Thank you for the feedback.
 
It's our understanding that insurance will pay if it is performed by a Phlebotomist only. We have never received any payment from carriers when our Ortho Surgeons perform the service.
 
Our rep gave us some paperwork on billing the PRP injection - though this is only done as self pay as none of our payers will authorize the treatment since it is experimental. We have been informed to bill only the 0232T - this, for now, includes everything that the procedure entails.
 
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