Does M0076 require prior authorization?

Yes, M0076 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for M0076?

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

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`M0076`, Prolotherapy

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Claims must include documentation that the service met the reasonable and necessary requirements and other documentation elements as required by LCD L35010.
When billing non-covered trigger point injections, include the appropriate Medicare modifier on the claim per Medicare billing rules.
This article contains billing, coding, or guideline information that complements the LCD; specific documentation, prior authorization, or forms are not specified here and must be obtained from the LCD or payer.
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.

Key Coverage Criteria

Trigger point injections are covered when they meet the reasonable and necessary clinical criteria specified in Local Coverage Determination L35010.
This article does not list specific covered indications; coverage is determined by the referenced Local Coverage Determination (LCD) for Platelet Rich Plasma.
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.

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

A58609, Billing and Coding: Platelet Rich Plasma

NGS-J6-L38937, Platelet Rich Plasma

FIRST_COAST-L39071, Platelet Rich Plasma

A58810, Billing and Coding: 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

NGS-JK-L38937, Platelet Rich Plasma

A57751, Billing and Coding: Trigger Point Injections

NOVITAS-JL-L39068, Platelet Rich Plasma

A58808, Billing and Coding: Platelet Rich Plasma

PALMETTO-JM-L38745, Platelet Rich Plasma

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

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

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

EVICORE-HPLAN-HAP-AB9D421BCDBD, Health Alliance Plan MSK Code List - Effective 01/01/2026

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

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

Ask Backwork about M0076 Sign up free

M0076, Prolotherapy

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Claims must include documentation that the service met the reasonable and necessary requirements and other documentation elements as required by LCD L35010.
When billing non-covered trigger point injections, include the appropriate Medicare modifier on the claim per Medicare billing rules.
This article contains billing, coding, or guideline information that complements the LCD; specific documentation, prior authorization, or forms are not specified here and must be obtained from the LCD or payer.
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.

Key Coverage Criteria

Trigger point injections are covered when they meet the reasonable and necessary clinical criteria specified in Local Coverage Determination L35010.
This article does not list specific covered indications; coverage is determined by the referenced Local Coverage Determination (LCD) for Platelet Rich Plasma.
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.

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

A58609, Billing and Coding: Platelet Rich Plasma

NGS-J6-L38937, Platelet Rich Plasma

FIRST_COAST-L39071, Platelet Rich Plasma

A58810, Billing and Coding: 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

NGS-JK-L38937, Platelet Rich Plasma

A57751, Billing and Coding: Trigger Point Injections

NOVITAS-JL-L39068, Platelet Rich Plasma

A58808, Billing and Coding: Platelet Rich Plasma

PALMETTO-JM-L38745, Platelet Rich Plasma

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

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

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

EVICORE-HPLAN-HAP-AB9D421BCDBD, Health Alliance Plan MSK Code List - Effective 01/01/2026

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

Have a follow-up question?

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

Ask Backwork about M0076 Sign up free

`M0076`, Prolotherapy

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M0076`, Prolotherapy

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M0076, Prolotherapy

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M0076, Prolotherapy

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M0076`, Prolotherapy

`M0076`, Prolotherapy