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    v1.0.28
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0465-prp-diabetic-wound-therapy
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    HCPCS G0465: Autologous PRP for Diabetic Chronic Wounds

    Medicare pays $1113 on average nationally for this procedure.

    HCPCS Level II code G0465 describes autologous platelet-rich plasma (PRP) or other blood-derived product treatment for diabetic chronic wounds/ulcers using an FDA-cleared device for this indication; the service includes applicable administration, dressings, phlebotomy, centrifugation or mixing, and preparatory procedures per treatment. Service type: biologic wound therapy / topical autologous blood product administration. Typical site of service: outpatient clinic, wound care center, or hospital outpatient department.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male with long-standing type 2 diabetes mellitus and peripheral neuropathy presents to a wound care clinic for evaluation of a nonhealing plantar foot ulcer present for 10 weeks despite standard care (debridement, offloading, moist dressings, and topical antimicrobials). Wound measurement shows a 2.4 cm diameter full-thickness ulcer without exposed bone, signs of ischemia, or acute infection. The multidisciplinary wound care team (podiatry or wound care physician and a certified wound care nurse) determines the patient is an appropriate candidate for autologous platelet-rich plasma (PRP) therapy using an FDA-cleared device for diabetic chronic wounds.

    Clinical workflow:

    • Initial evaluation and documentation of wound history, size, depth, circulation, and neuropathy.

    • Baseline photography and measurement; obtain informed consent specific to autologous blood-derived product application.

    • Phlebotomy performed in clinic; blood processed via FDA-cleared centrifuge/mixing device to derive PRP per manufacturer instructions.

    • Wound bed preparation (sharp or mechanical debridement as indicated) and irrigation.

    • Application/administration of autologous PRP to the wound; placement of appropriate primary and secondary dressings.

    • Post-procedure instructions and schedule for follow-up visits for dressing changes, repeat treatments (per payer or device guidance), and reassessment of wound healing progress.

    • Documentation includes device used (FDA-cleared for diabetic chronic wounds), volume of blood drawn, processing steps (centrifugation), administration, and any immediate adverse events.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11042Debridement, subcutaneous tissue, first 20 sq cm or lessCommonly used for surgical debridement of necrotic tissue prior to PRP application when deeper debridement is required.
    11043Debridement, muscle and fascia, first 20 sq cm or lessUsed when debridement extends into muscle/fascia before PRP placement.
    36415Collection of venous blood by venipunctureUsed for the phlebotomy step to obtain autologous blood for PRP processing.
    99070Supplies and materials (e.g., dressings, supplies) provided by the physicianUsed to report miscellaneous supplies such as specialized dressings or device disposables not included in the PRP code per payer rules.
    97597Debridement (e.g., high frequency, sharp), with or without anesthesia; selective debridement, without anesthesia, first 20 sq cm

    Note: If a related CPT code list was provided in the input, those codes would be listed here. Otherwise, the table above identifies commonly performed CPT services in the clinical workflow surrounding autologous PRP for diabetic chronic wounds.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    363LA2200XAdult Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    207QA0401XAddiction Medicine (Family Medicine) PhysicianA family medicine physician who specializes in the diagnosis and treatment of addictions.
    204F00000XTransplant Surgery PhysicianA surgeon who specializes in transplant surgery.
    261QM1100XMilitary/U.S. Coast Guard Outpatient Clinic/CenterThe Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental serv…
    2080P0214XPediatric Pulmonology PhysicianA pediatrician dedicated to the prevention and treatment of all respiratory diseases affecting infants, children and young adults. This specialist is …

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    E10.621Type 1 diabetes mellitus with foot ulcer
    E10.622Type 1 diabetes mellitus with other skin ulcer
    E10.65Type 1 diabetes mellitus with hyperglycemia
    E10.69Type 1 diabetes mellitus with other specified complication
    E11.621Type 2 diabetes mellitus with foot ulcer
    E11.622Type 2 diabetes mellitus with other skin ulcer
    E11.65Type 2 diabetes mellitus with hyperglycemia
    E11.69Type 2 diabetes mellitus with other specified complication
    I83.10Varicose veins of unspecified lower extremity with inflammation
    I83.11Varicose veins of right lower extremity with inflammation

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    7 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

    HCPCS G0009: Administration of Pneumococcal Vaccine

    HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

    HCPCS G0010: Administration of Hepatitis B Vaccine

    HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

    HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

    HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

    HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

    HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

    HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Showing 1–10 of 1996

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    May be used for selective sharp debridement as part of wound bed preparation prior to PRP application.
    67028Intravitreal injection (example unrelated)Data not available in the input.