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Medical Coding News Archives

PRP Wound Treatment Remains Noncovered Under New Policy

May 13, 2008:
Treatment of chronic nonhealing wounds using platelet-rich plasma (PRP) is still noncovered, according to a coverage policy recently updated by The Centers for Medicare and Medicaid Services (CMS).

The policy defines different types of wounds and indicates that wounds are categorized as either acute, wherein the normal four stages of wound healing are not yet completed but are expected to occur, or chronic, wherein the wound has failed to progress through the normal wound-healing stages and repair itself within a sufficient time period.

The policy also defines PRP as being produced in an autologous or homologous manner: autologous PRP comprises blood from the patient who will ultimately receive the PRP, whereas homologous PRP is derived from blood from multiple donors.

When the agency reconsidered the treatment modality, it decided that the evidence is not adequate to conclude that autologous PRP is reasonable and necessary and therefore will remain a noncovered service for treating chronic nonhealing, cutaneous wounds. The policy states the evidence is not adequate to conclude that autologous PRP is reasonable and necessary for treating acute surgical wounds when applied directly to the closed incision, or for dehiscent wounds.

Deborah C. Hall
Clinical/Technical Editor


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