Does P9020 require prior authorization?

No, P9020 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for P9020?

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

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`P9020`, Platelet rich plasma, each unit

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

This billing and coding guidance complements Local Coverage Determination (LCD) L38745 for Platelet Rich Plasma; refer to LCD L38745 for specific clinical indications, coverage rules, and required documentation.
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.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Key Coverage Criteria

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.
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.

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

A58808, Billing and Coding: Platelet Rich Plasma

NOVITAS-JL-L39068, Platelet Rich Plasma

PALMETTO-JM-L38745, Platelet Rich Plasma

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

A58282, Billing and Coding: 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

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

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P9020, Platelet rich plasma, each unit

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

This billing and coding guidance complements Local Coverage Determination (LCD) L38745 for Platelet Rich Plasma; refer to LCD L38745 for specific clinical indications, coverage rules, and required documentation.
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.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Key Coverage Criteria

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.
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.

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

A58808, Billing and Coding: Platelet Rich Plasma

NOVITAS-JL-L39068, Platelet Rich Plasma

PALMETTO-JM-L38745, Platelet Rich Plasma

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

A58282, Billing and Coding: 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

Have a follow-up question?

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

Ask Backwork about P9020 Sign up free

`P9020`, Platelet rich plasma, each unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`P9020`, Platelet rich plasma, each unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

P9020, Platelet rich plasma, each unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

P9020, Platelet rich plasma, each unit

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`P9020`, Platelet rich plasma, each unit

`P9020`, Platelet rich plasma, each unit