The Record - for physicians and other health care providers to share with their office staffs
Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
September 2013

Audit identifies inappropriately paid claims for autologous PRP injections

Inappropriately paid claims for autologous platelet rich plasma preparations and injections have been identified through recent utilization review trend analysis and audits.

BCBSM medical policy titled “Recombinant and Autologous Platelet-Derived Growth Factors as a Treatment of Wound Healing and Other Conditions” states that the use of autologous platelet-derived growth factors or autologous platelet concentrate and/or gel  has not been established and is, therefore, considered experimental. You can find the policy by looking up procedure code *0232T in Benefit Explainer, available through web-DENIS.

Upon review, recovery will be requested for paid claims associated with the retrieval and administration of autologous PRP injections, unless the procedure is specifically listed as a member contract benefit. As always, continue to use the Benefit Explainer tool to check member benefits.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.