Platelet Rich Plasma
J9 · Effective Dec 12, 2021
17 active Medicare policies list M0076, and 6 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J9 · Effective Dec 12, 2021
J6 · Effective Aug 1, 2021
JK · Effective Aug 1, 2021
JH · Effective Dec 12, 2021
JL · Effective Dec 12, 2021
JJ · Effective Feb 7, 2021
JM · Effective Feb 7, 2021
J15 · Effective Jan 3, 2022
JE · Effective Jan 23, 2022
JF · Effective Jan 23, 2022
6 policies from 6 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of M0076 |
|---|---|---|
| Prolotherapy and Sclerotherapy | Apr 11, 2023 | Covered |
| Policy | Effective | Status of M0076 |
|---|---|---|
| Health Alliance Plan MSK Code List - Effective 01/01/2026 | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of M0076 |
|---|---|---|
| Prolotherapy | Apr 1, 2026 | Covered |
National · Effective Jul 1, 2023
J6 · Effective Aug 1, 2021
JL · Effective Jul 1, 2023
J9 · Effective Jul 1, 2023
National · Effective Nov 22, 2023
National · Effective Sep 11, 2025
JL · Effective Jan 1, 2026
| Policy | Effective | Status of M0076 |
|---|---|---|
| Prolotherapy and Platelet Rich Plasma Therapies | Jan 1, 2026 | Covered |
| Policy | Effective | Status of M0076 |
|---|---|---|
| Prolotherapy and Platelet Rich Plasma Therapies | Jan 1, 2026 | Covered |
| Policy | Effective | Status of M0076 |
|---|---|---|
| Prolotherapy and Platelet Rich Plasma Therapies | Jan 1, 2026 | Covered |