Based upon the limited information I can find on the topics, it appears that what is was termed intraosseous bioplasty is actually an ACP/PRP injection - which is not separately payable when performed with another procedure OR is deemed experimental by the majority of payers (CPT 0232T).
This procedure is very similar to subchondroplasy, which is usually performed with arthroscopy, where calcium phosphate is injected into the defect. Subchondroplasty codes to 29855-6 for tibial plateau or unlisted 29999 for femoral condyle.
Is the difference between subchondroplasy and intraosseous bioplasty (ACP/PRP injections) basically only the substance being injected?
These procedures are so similar yet one seems billable and the other is not...?
Per CPT Assistant 2019, Question: A patient presents with a stress injury resulting in a bone marrow lesion of the medial tibial plateau. The physician performs a percutaneous arthroscopically assisted reinforcement of the stress injury using an arthroscope for visualization and for injection of calcium phosphate ( or other bone void filler) into the medial tibial plateau bone defect. The cannula is manipulated within the involved area to maximize reinforcement of the medial tibial metaphysis. A total of 10 mL of calcium phosphate is injected. Would it be appropriate to report CPT code 29855? Answer: There is no specific CPT code that accurately describes this procedure. Therefore, CPT code 29999, Unlisted procedure, arthroscopy, should be reported for the procedure described in the question. Code 29855, Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy), is appropriately reported for arthroscopically aided management of intra-articular fractures of the tibial plateau that typically require reduction of the fracture and/or internal fixation. This code is not appropriate for injection of calcium phosphate into a bone-marrow lesion that does not require a reduction .
Per CPT Assistant 2018, Question: A patient developed a medial femoral condyle insufficiency fracture. To repair the defect, the surgeon utilized fluoroscopic visualization and an intraosseous device to inject 5 ml of calcium phosphate into the defect of the medial femoral condyle via small poke holes. Would it be appropriate to report code 27509 for this procedure? Answer: No, it would not be appropriate to report code 27509, Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separation, for this procedure. The surgeon is filling an osteoporotic area of bone with bone filler and not performing skeletal fixation of the fracture. Consequently, the procedure that was performed does not fit the description of an existing specific CPT code and would instead be reported with code 27599, Unlisted procedure, femur or knee.
From my understanding, when no reduction of the fracture is performed and/or no internal fixation is applied, an unlisted code (CPT 29999 vs 27599) would be reported for the ACP injection.
If the fracture is reduced or internal fixation is applied, the appropriate fracture care code would be reported. The ACP injection would basically be a free service.
**Check payer policies to see if ACP injections are investigational/experimental, as many payers do.