Wiki PRP and Stem Cell

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Jennifer17

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Hello, I was wondering how you code for PRP injections and Stem cell injections and do you have patients self pay or do you bill insurances for these with success. what CPT code and fee do you bill?
Thanks in advance,
 
We offer it to our patients as self-pay only. However, if the provider performs BMAC during surgery or if the patient requires an itemized receipt with a CPT code we use the unlisted code that coincides with the appropriate body part.
 
jennifers said:
Hello, I was wondering how you code for PRP injections and Stem cell injections and do you have patients self pay or do you bill insurances for these with success. what CPT code and fee do you bill?
Thanks in advance,
Click to expand...
Hi there,
Coverage for this service is extremely limited. I've yet to see payers cover this for pain or other musculoskeletal conditions, but they may cover it for non-healing wounds. Medicare lists them as carrier-priced codes.

They are reported with the following T codes:
0263T Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure including unilateral or bilateral bone marrow harvest
0264T Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure excluding bone marrow harvest
0265T Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; unilateral or bilateral bone marrow harvest only for intramuscular autologous bone marrow cell therapy
0232T Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed
 
Can anyone tell me how you are pricing this 0263T for optimal reimbursement? If it's non covered, I am wondering where the cost to the patient would fall? Our orthopedic practice is looking to do this soon. Thank you
 
TJAlexander said:
We offer it to our patients as self-pay only. However, if the provider performs BMAC during surgery or if the patient requires an itemized receipt with a CPT code we use the unlisted code that coincides with the appropriate body part.
Click to expand...
How did you determine the fee for this 0232T cpt code? It was scheduled to sunset this month but was extended until 1/2027 and now my providers are looking to do this for our patients.
Thank you for any suggestions you have.
 
Agree with the advice above. Some work comp payers will pay for it with prior auth. Pricing can be determined working with supply to determine the cost of the kits and with providers to determine the work being done, etc. I have personally never seen this covered except by Work Comp. In my past experience with both stem cell and PRP it was self pay.
 
We determine the pricing based on cost, the number of joints treated, and provider work. Like Amyjph, the only time we've been paid by insurance for PRP was workers comp.
 
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