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PRP gets CPT Category III code

By Matthew Twetten

On July 1, 2010, the American Medical Association (AMA) Current Procedural Terminology (CPT) introduced a new category III (new technology) code for the performance of platelet rich plasma (PRP) injection procedures. The specific wording of the code follows:

“0232T—Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed (Do not report 0232T in conjunction with 20550, 20551, 20600-20610, 20926, 76942, 77002, 77012, 77021, 86965.)”

The new code must be used by orthopaedic surgeons who perform PRP injections in reporting performance of the procedure in lieu of whatever single code, or combination of codes, they had been using previously. The new code cannot be billed in conjunction with other injection procedure codes such as 20550, 20551, 20600, 20605, or 20610.

The new code includes the harvesting of the blood, spinning of the blood, and injection of the remaining plasma. None of these steps can be billed any longer nor can orthopaedic surgeons use these other codes in place of 0232T. Under CPT rules, physicians must use the most accurate code available, which, for PRP injections, is now the new category III code.

The new code is to be used only when PRP is performed in a complete separate patient encounter from a surgical procedure.

Any time a physician uses PRP as part of a larger reconstruction or repair (traumatic or nontraumatic) procedure, it is not separately billable.

Unlike Category I CPT surgical procedure codes, Category III codes do not have an assigned Medicare value and are therefore priced by regional carriers. Physicians will need to estimate the work involved in providing the service.

For more information on this code and its correct usage and application, please contact me at twetten@aaos.org

Matthew Twetten is the senior health policy analyst in the AAOS department of medical affairs.

AAOS Now
August 2010 Issue
http://www.aaos.org/news/aaosnow/aug10/managing9.asp