New and revised HCPCS Level II codes for platelet rich plasma

Platelet rich plasma (PRP) is considered “regenerative” medicine — therapies that replace/regenerate, repair, and restore damaged tissues or organs — and is used widely more and more across all areas of medicine. It is used to treat a variety of conditions, including injuries of the musculoskeletal system — such as injuries to tendons, joints and ligaments, diseases of the joints such as osteoarthritis, as well as the promotion of chronic wound/ulcer healing, among others. PRP is made up of blood plasma (the liquid portion of blood), concentrated platelets (a type of blood cell), growth factors and cytokines (cells...

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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews CMS changes affecting platelet rich plasma (PRP) billing and reporting, with emphasis on chronic wound and ulcer applications. It is useful for coders, billers, compliance staff, and clinical documentation teams who need a high-level understanding of the relevant HCPCS Level II and CPT Category III code updates, effective dates, and related CMS guidance.

Why This Topic Matters

PRP is used in a range of clinical settings, but reporting requirements can differ based on the condition being treated and the payer guidance in effect. Understanding the CMS update helps healthcare organizations align documentation and claims reporting with the applicable PRP code structure and effective dates.

What You Will Learn

  • How PRP is described in the context of regenerative medicine and wound care
  • Which CMS reporting updates are highlighted for PRP-related services
  • How the article frames the distinction between diabetic and nondiabetic chronic wound applications
  • What general CMS guidance and effective-date information are referenced

Who Should Read This

  • Medical coders
  • Billing staff
  • Compliance professionals
  • Revenue cycle teams
  • Clinicians documenting PRP services

Codes Discussed

Modifiers Discussed


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