Does S9055 require prior authorization?

No, S9055 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 S9055?

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

Backwork Sign up free

`S9055`, Procuren or other growth factor preparation to promote wound healing

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.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Key Coverage Criteria

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.
Services billed under HCPCS G0465 (blood-derived products for chronic non-healing wounds) are subject to National Coverage Determination 270.3 and coverage follows NCD 270.3 rules.
Platelet-poor plasma (PPP) or platelet-rich plasma (PRP) injection for all indications including (not an all-inclusive list): Achilles tendon ruptures / Achilles tendinopathy; alopecia areata (androgenetic alopecia); ankle sprain; anterior cruciate ligament (ACL) surgery; as adjunctive material to bone graft; avascular necrosis of the hip and the shoulder; carpometacarpal arthritis of the thumb; cerebral palsy; chronic wounds; Crohn's disease-related perianal fistula; discogenic low back pain; f [...]
Adipose-tissue-derived stem cells (Habeo cell therapy) for the treatment of chondromalacia patellae, knee osteoarthritis, scleroderma (systemic sclerosis), and all other indications.

14 Active Policies

FIRST_COAST-L39071, Platelet Rich Plasma

A58810, Billing and Coding: Platelet Rich Plasma

NOVITAS-JH-L39068, Platelet Rich Plasma

PALMETTO-JJ-L38745, Platelet Rich Plasma

NOVITAS-JL-L39068, Platelet Rich Plasma

A58808, Billing and Coding: Platelet Rich Plasma

PALMETTO-JM-L38745, Platelet Rich Plasma

AETNA-CPB-0244, Skin and Soft Tissue Substitutes

A58282, Billing and Coding: Platelet Rich Plasma

AETNA-CPB-0784, Blood and Adipose Tissue Derived Products for Selected Indications

AETNA-CPB-0411, Bone and Tendon Graft Substitutes and Adjuncts

AETNA-CPB-0549, Distraction Osteogenesis for Craniofacial Defects

AETNA-CPB-0005, Septoplasty and Rhinoplasty

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

`S9055`, Procuren or other growth factor preparation to promote wound healing

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

S9055, Procuren or other growth factor preparation to promote wound healing

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

`S9055`, Procuren or other growth factor preparation to promote wound healing