Does G0460 require prior authorization?

No, G0460 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for G0460?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0460`, Autologous platelet rich plasma or other blood-derived product for non-diabetic

HCPCS/CPT

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Billing, coding, and supporting documentation requirements are provided as a complement to LCD L39023; claims must include the documentation required by LCD L39023.
Follow the Local Coverage Determination L39058 and CMS NCD 270.3 for clinical indications and supporting documentation to justify PRP use and appropriate code selection.
When billing P9020, document the number of PRP units transfused (bill one or more P9020 units equal to units transfused); when billing 0232T, document that a kit was used to prepare PRP and that the service is an injection.
The submitted medical record must support the use of the selected ICD-10-CM code(s).
The submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Key Coverage Criteria

Refer to Local Coverage Determination L39023 for covered indications for platelet-rich plasma (PRP) injections for non-wound indications.
Platelet-rich plasma (PRP) used for treatment of chronic non-healing wounds is covered when it meets CMS National Coverage Determination (NCD) 270.3; bill using HCPCS G0460/G0465 accordingly.
HCPCS P9020 should be billed for one or more units of PRP transfused when used to treat conditions or coagulopathies for which PRP transfusion is indicated.
Platelet-rich plasma (PRP) is covered only when the service meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L39068.
When billing for G0465 (blood-derived products for chronic non-healing wounds), coverage follows National Coverage Determination (NCD) 270.3 and must meet that NCD's criteria.
Coverage for platelet-rich plasma (PRP) is determined by Local Coverage Determination L39071; PRP is covered only when reasonable and necessary per that LCD.

20 Active Policies

CGS-J15-L39023, Platelet Rich Plasma Injections for Non-Wound Injections

J15

CGS-J18-L39023, Platelet Rich Plasma Injections for Non-Wound Injections

J18

A58810, Billing and Coding: Platelet Rich Plasma

FIRST_COAST-L39071, Platelet Rich Plasma

NORIDIAN-JE-L39058, Platelet Rich Plasma Injections for Non-Wound Injections

NORIDIAN-JF-L39058, Platelet Rich Plasma Injections for Non-Wound Injections

NOVITAS-JH-L39068, Platelet Rich Plasma

PALMETTO-JJ-L38745, Platelet Rich Plasma

A58808, Billing and Coding: Platelet Rich Plasma

NOVITAS-JL-L39068, Platelet Rich Plasma

PALMETTO-JM-L38745, Platelet Rich Plasma

AETNA-CPB-0005, Septoplasty and Rhinoplasty

AETNA-CPB-0602, Intradiscal Procedures

UMR-POL-UMR-prolotherapy-platelet-rich-plasma-therapies, Prolotherapy and Platelet Rich Plasma Therapies

SUREST-POL-SUREST-prolotherapy-platelet-rich-plasma-therapies, Prolotherapy and Platelet Rich Plasma Therapies

UHCMA-POL-UHC_MA-platelet-rich-plasma-therapies, Platelet Rich Plasma Therapies

ANTHEM-MED.00110, Silver-based Products for Wound and Soft Tissue Applications

ANTHEM-MP-B094276, TRANS.00035 Therapeutic use of Stem Cells, Blood and Bone Marrow Products

A58737, Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections

A58788, Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections

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Ask Backwork about documentation requirements, denial risks, or coverage in your state.

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G0460, Autologous platelet rich plasma or other blood-derived product for non-diabetic

HCPCS/CPT

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Billing, coding, and supporting documentation requirements are provided as a complement to LCD L39023; claims must include the documentation required by LCD L39023.
Follow the Local Coverage Determination L39058 and CMS NCD 270.3 for clinical indications and supporting documentation to justify PRP use and appropriate code selection.
When billing P9020, document the number of PRP units transfused (bill one or more P9020 units equal to units transfused); when billing 0232T, document that a kit was used to prepare PRP and that the service is an injection.
The submitted medical record must support the use of the selected ICD-10-CM code(s).
The submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Key Coverage Criteria

Refer to Local Coverage Determination L39023 for covered indications for platelet-rich plasma (PRP) injections for non-wound indications.
Platelet-rich plasma (PRP) used for treatment of chronic non-healing wounds is covered when it meets CMS National Coverage Determination (NCD) 270.3; bill using HCPCS G0460/G0465 accordingly.
HCPCS P9020 should be billed for one or more units of PRP transfused when used to treat conditions or coagulopathies for which PRP transfusion is indicated.
Platelet-rich plasma (PRP) is covered only when the service meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L39068.
When billing for G0465 (blood-derived products for chronic non-healing wounds), coverage follows National Coverage Determination (NCD) 270.3 and must meet that NCD's criteria.
Coverage for platelet-rich plasma (PRP) is determined by Local Coverage Determination L39071; PRP is covered only when reasonable and necessary per that LCD.

20 Active Policies

CGS-J15-L39023, Platelet Rich Plasma Injections for Non-Wound Injections

J15

CGS-J18-L39023, Platelet Rich Plasma Injections for Non-Wound Injections

J18

A58810, Billing and Coding: Platelet Rich Plasma

FIRST_COAST-L39071, Platelet Rich Plasma

NORIDIAN-JE-L39058, Platelet Rich Plasma Injections for Non-Wound Injections

NORIDIAN-JF-L39058, Platelet Rich Plasma Injections for Non-Wound Injections

NOVITAS-JH-L39068, Platelet Rich Plasma

PALMETTO-JJ-L38745, Platelet Rich Plasma

A58808, Billing and Coding: Platelet Rich Plasma

NOVITAS-JL-L39068, Platelet Rich Plasma

PALMETTO-JM-L38745, Platelet Rich Plasma

AETNA-CPB-0005, Septoplasty and Rhinoplasty

AETNA-CPB-0602, Intradiscal Procedures

UMR-POL-UMR-prolotherapy-platelet-rich-plasma-therapies, Prolotherapy and Platelet Rich Plasma Therapies

SUREST-POL-SUREST-prolotherapy-platelet-rich-plasma-therapies, Prolotherapy and Platelet Rich Plasma Therapies

UHCMA-POL-UHC_MA-platelet-rich-plasma-therapies, Platelet Rich Plasma Therapies

ANTHEM-MED.00110, Silver-based Products for Wound and Soft Tissue Applications

ANTHEM-MP-B094276, TRANS.00035 Therapeutic use of Stem Cells, Blood and Bone Marrow Products

A58737, Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections

A58788, Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about G0460 Sign up free

`G0460`, Autologous platelet rich plasma or other blood-derived product for non-diabetic

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G0460`, Autologous platelet rich plasma or other blood-derived product for non-diabetic

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G0460, Autologous platelet rich plasma or other blood-derived product for non-diabetic

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G0460, Autologous platelet rich plasma or other blood-derived product for non-diabetic

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G0460`, Autologous platelet rich plasma or other blood-derived product for non-diabetic

`G0460`, Autologous platelet rich plasma or other blood-derived product for non-diabetic