CurrentCignaPolicy 0507

Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])

Customize your policy alerts

Sign up for Cigna Policy 0507 alerts

Get alerted when Policy 0507 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy addresses proposed uses of autologous platelet-derived growth factors, also called platelet-rich plasma (PRP), for multiple conditions and indications. It applies to health benefit plans administered by Cigna Companies, subject to the applicable benefit plan document and controlling laws or mandates.

Policy Summary

PayerCigna

PolicyAutologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])

Policy CodePolicy 0507

Change TypeAnnual reviewno material changes

Effective DateOct 15, 2026

Next Review DateOct 15, 2027

Key ActionSubmit covered codes and diagnoses because claims without covered codes or covered conditions will be denied as not covered.

SourceLink

POLICY UPDATE CHANGES

Annual review entries state that there were no clinical policy statement changes.

UnprovenPRP coverage classification

Any indicationScope of classification

0232TCPT code identified

G0460HCPCS code identified

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentCignaPolicy 0507

Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])

Customize your policy alerts

Sign up for Cigna Policy 0507 alerts

Get alerted when Policy 0507 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerCigna

PolicyAutologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])

Policy CodePolicy 0507

Change TypeAnnual reviewno material changes

Effective DateOct 15, 2026

Next Review DateOct 15, 2027

Key ActionSubmit covered codes and diagnoses because claims without covered codes or covered conditions will be denied as not covered.

SourceLink

POLICY UPDATE CHANGES

Annual review entries state that there were no clinical policy statement changes.

UnprovenPRP coverage classification

Any indicationScope of classification

0232TCPT code identified

G0460HCPCS code identified

3Annual review entries

Coverage Determination

All PRP indications are experimental, investigational, or unproven

Use of autologous platelet-derived growth factors is considered experimental, investigational, or unproven for any condition or indication.

Any condition or indication

Listed example indications: Examples include ACL repair; bone graft supplementation, regeneration, substitution and/or healing; degenerative joint disease; epicondylitis; persistent epithelial defects of the cornea; fractures including long-bone nonunion; joint capsular injuries; muscle injuries and disorders; knee osteoarthritis; periodontal disease, gingival recession and dental surgery; plantar fasciitis; sinus augmentation procedures; soft tissue trauma such as tendon and ligament ruptures; total knee arthroplasty; tendonitis; and wound healing including surgical wounds, chronic wounds and lower-extremity ulcers.
The policy applies the classification to any condition or indication, not only the examples listed.

PRP services are experimental, investigational, or unproven

PRP services are considered experimental, investigational, or unproven.

Experimental or unproven status: Autologous platelet-derived growth factors and platelet-rich plasma are considered experimental, investigational, or unproven for the identified services and indications.

The policy background states that there is insufficient evidence to support PRP for any indication, including use in combination with other substances.

PRP use for any indication

PRP is not supported by sufficient evidence for the indications described in this policy.

Insufficient evidence: Use of autologous platelet-derived growth factors or platelet-rich plasma lacks sufficient evidence for any indication, including use in combination with other substances.

This conclusion applies broadly across the proposed indications.

Autologous platelet-derived growth factors (APDGF), also called platelet-rich plasma (PRP), are considered experimental, investigational, or unproven for any condition or indication. This applies whether billed under CPT 0232T or HCPCS G0460. Examples specifically listed in the policy include ACL repair, bone graft supplementation or healing, degenerative joint disease, epicondylitis, persistent corneal epithelial defects, fractures including long-bone nonunion, joint capsular injuries, muscle injuries, knee osteoarthritis, periodontal and dental procedures, plantar fasciitis, sinus augmentation, soft-tissue trauma, total knee arthroplasty, tendonitis, and wound healing, including surgical wounds, chronic wounds, and lower-extremity ulcers.

PRP is not supported for coverage as a non-surgical intervention for osteoarthritis. Although some studies reported statistically significant improvements, the policy identifies lack of long-term efficacy data, absence of regulatory standardization, and inconsistent clinical outcomes as reasons coverage is not supported. Further high-quality, standardized trials are needed before PRP can be considered a reliable alternative to established osteoarthritis treatments.

Coding Information

Experimental, investigational, or unproven procedure codesCPTExperimental

0232T

Autologous platelet-derived growth factors

Experimental, investigational, or unproven procedure codesHCPCSExperimental

G0460

Autologous platelet-derived growth factors

Considered Experimental/Investigational/Unproven: CPTCPTExperimental

0232T

Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed

Considered Experimental/Investigational/Unproven: HCPCS CodesHCPCSExperimental

G0460

Autologous platelet rich plasma (PRP) or other blood-derived product for nondiabetic chronic wounds/ulcers (includes, as applicable: administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment)

Provider and Billing Guidance

Billing Rule

Submit covered codes and diagnoses

Submit claims using the most appropriate covered procedure and diagnosis codes effective on the submission date. Claims without covered code(s) under the applicable Coverage Policy will be denied as not covered, and reimbursement is not allowed when services are billed for conditions or diagnoses that are not covered.

Use covered procedure code(s) and covered diagnosis code(s).
Review the applicable benefit plan document and Coverage Policy before submitting the claim.

Denial Risk

Expect denial for PRP across all indications

Use of autologous platelet-derived growth factors/PRP is considered experimental, investigational, or unproven for any condition or indication. Claims may be denied even when PRP is billed under CPT 0232T or HCPCS G0460.

Policy Background

This policy addresses proposed uses of autologous platelet-derived growth factors (APDGF), also referred to as platelet-rich plasma (PRP). APDGF/PRP is derived from an individual's own blood, with platelets as the principal component; the blood is collected and processed to concentrate platelets and proposed growth factors for application to a wound or other treatment site. Related terminology includes platelet gel, platelet-rich concentrate, autogenous platelet gel, plasma rich in growth factors, and platelet releasate.

The policy scope spans orthopedic and musculoskeletal uses as well as dental, ophthalmic, and wound-healing indications. Preparation systems are generally cleared through the FDA 510(k) process for preparing autologous PRP or platelet concentrates, while PRP itself is categorized as minimally manipulated tissue and an autologous blood product. Across the proposed uses addressed by the policy, APDGF/PRP is considered experimental, investigational, or unproven for any condition or indication.

Terms and Product Definitions

APDGF and PRP terminology

Primary termAutologous platelet-derived growth factors (APDGF)

Equivalent termPlatelet-rich plasma (PRP)

Terminology relationshipAPDGF is also referred to as PRP.

Autologous platelet-derived growth factors

SourceDerived from the individual's own blood.

Main constituentPlatelets are the main constituent.

Other namesAlso referred to as platelet gel, platelet-rich concentrate, autogenous platelet gel, plasma rich in growth factors, or platelet releasate.

Policy Summary

PayerCigna

PolicyAutologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])

Policy CodePolicy 0507

Change TypeAnnual reviewno material changes

Effective DateOct 15, 2026

Next Review DateOct 15, 2027

Key ActionSubmit covered codes and diagnoses because claims without covered codes or covered conditions will be denied as not covered.

SourceLink

On This Page

CPT 0232T: Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed.
HCPCS G0460: Autologous platelet rich plasma (PRP) or other blood-derived product for nondiabetic chronic wounds/ulcers.

Denial Risk

Nondiabetic wound and ulcer PRP is unproven

Claims for platelet-rich plasma injection or autologous PRP or other blood-derived products for nondiabetic chronic wounds or ulcers are subject to denial because these services are considered experimental, investigational, or unproven.

This applies to CPT 0232T and HCPCS G0460.
HCPCS G0460 includes administration, dressings, phlebotomy, centrifugation or mixing, and other preparatory procedures, per treatment, as applicable.

Denial Risk

Insufficient evidence supports denial

PRP is subject to denial because the policy states that there is insufficient evidence to support its use for any indication, including wound-healing applications and use in combination with other substances.

The policy conclusion applies broadly across proposed indications.
Wound uses include surgical wounds, chronic wounds, and lower-extremity ulcers.

Denial Risk

Non-surgical osteoarthritis PRP is not supported

Do not expect coverage for PRP as a non-surgical intervention for osteoarthritis. The policy cites insufficient long-term efficacy data, absence of regulatory standardization, and inconsistent clinical outcomes, and calls for further high-quality, standardized trials before PRP can be considered a reliable alternative to established osteoarthritis treatments.

The limitation applies to non-surgical PRP intervention for osteoarthritis.
Statistical significance in reported studies does not establish coverage under the policy.

Platelet-rich plasma

Product typeA blood-derived product.

PreparationPrepared by collecting and processing a small sample of the individual's own blood.

PurposeConcentrates platelets and proposed growth factors for application to a wound or other treatment site.

FDA status

PRP classificationPRP itself is categorized as minimally manipulated tissue and an autologous blood product.

Preparation-system pathwaySystems used to prepare autologous PRP or platelet concentrate are generally approved under the FDA 510(k) process.

Point of usePreparation systems are generally approved for use at the patient's point of care and/or in a clinical laboratory.

APDGF product and preparation

Product sourceDerived from autologous blood.

Preparation systemA collection and preparation system is used to obtain a small blood sample and produce PRP.

Further preparationPRP may be combined with other substances to form a platelet-rich gel.

Common PRP terminology

Common namePlatelet-rich plasma (PRP) is a commonly used name for autologous platelet-derived growth factors.

Related productsThe term also encompasses related autologous platelet products.

Autologous sourceThese products are derived from the individual's own blood.

Minimally manipulated tissue

FDA tissue categoryPRP itself is categorized as minimally manipulated tissue.

Product categoryPRP is an autologous blood product.

SourcePRP is prepared from the individual's own blood.

APDGF/PRP therapy

TherapyAutologous platelet-derived growth factor therapy.

Alternate terminologyAlso referred to as platelet-rich plasma injection.

AdministrationUses a preparation derived from the individual's own blood and administered by injection.

APDGF abbreviation

Policy abbreviationAutologous platelet-derived growth factors are abbreviated APDGF.

IdentificationAPDGF is identified with platelet-rich plasma (PRP).

RelationshipAPDGF and PRP refer to the same policy subject.

Autologous platelet concentrates

AbbreviationAutologous platelet concentrates are abbreviated APC.

Clinical contextAPC are evaluated as adjuncts to periodontal surgical therapies.

Procedures evaluatedThe periodontal therapies include open flap debridement, bone grafting, guided tissue regeneration, and enamel matrix derivative procedures.

Leukocyte-poor PRP

AbbreviationLeukocyte-poor platelet-rich plasma is abbreviated LP-PRP.

Surgical contextLP-PRP was studied as an adjunct during arthroscopic rotator cuff repair.

Study administration siteIn the reviewed studies, LP-PRP was administered at the bone-tendon interface.