Platelet-Rich Plasma Policy
Defines medical necessity and coverage for platelet-rich plasma (PRP) therapies across Independent Health lines of business (Commercial, Self-Funded, Medicare Advantage, and State products) including place-of-service limitations and Medicare policy references. Describes noncoverage as experimental/investigational for most indications and coverage for certain state plan settings.
Reviewed on 7/1/2025 with revised formatting only.
Coverage Summary
Independent Health policy M20130117011 (effective 2013-04-01; last reviewed 2025-07-01) takes a mixed coverage stance across lines of business. For Commercial and Self-Funded plans PRP and platelet-derived growth factors are considered experimental/investigational for all indications (not covered). Medicare Advantage follows the Commercial criteria except where CMS determinations apply (see CMS LCD/LCA and NCD references). For State products (MediSource, MediSource Connect, Child Health Plus, Essential Plan) PRP is a covered benefit only when performed in specified Article 28 places of service and is not covered in Article 11 provider offices. Preauthorization is required where applicable.