About this policy
Jurisdiction: JH MAC Part B. States: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas. Type: Active LCD
Coverage indications
Compliance with the provisions in this LCD may be monitored and addressed through post payment data analysis and subsequent medical review audits. Platelet rich plasma injections and/or applications are considered not medically reasonable and necessary for any use outside of the National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic Non-Healing Wounds.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.