Wiki PRP injection with Euflexxa

[Rhonda.L.Ratcliff@uth.tmc.edu]

My providers perform PRP injection along with the Hyaluronic Acid injection Euflexxa. I understand the PRP includes harvesting of blood, spinning and injection of remaining plasma which we perform and when the PRP is the only injection we do not bill the 20610. However, my question is if the patient is receiving the PRP and a Euflexxa which is separate from the PRP can we bill both? The PRP is billed as self pay.

 

[Orthocoderpgu]

We will need to paint with a broad brush for this. Generally speaking insurance companies won't pay for Euflexxa when performed PRP. Even though the PRP is self pay, if the insurance finds out that PRP was performed, good chance they will ask for their money back. I'm starting to see insurance companies ask up front if PRP will be performed as well and denying the pre-auth for the Euflexxa if it is.

 

[Rhonda.L.Ratcliff@uth.tmc.edu]

I appreciate your response. I will have to query the staff to find out if any of the insurance companies are asking about PRP when calling on Euflexxa's. Good to know!

 

[Rhonda.L.Ratcliff@uth.tmc.edu]

Another PRP / Euflexxa follow up question. Is there one over the other we should be billing? Does the PRP, 0232T take precedence over the euflexxa therefore that particular charge should be billed and not the Euflexxa or should we bill the Euflexxa?

 

[mattie7632]

Isn't your provider alternating the PRP / Euflexxa ? For example, Patient begins care and has his series of Euflexxa injections, in 3-6 months he has PRP to same location, 3-6 months later Euflexxa. (HA is repeated every 6 months). This is how our provider does it and we've never had issues such as above. Tricare is the only payer I know of that will pay for PRP if medical necessity criteria is met and referral on file.