Reimbursement

HCPCS Codes

• HCPCS G0465 – diabetic chronic wounds, FDA-cleared device

Autologous platelet-rich plasma (PRP) or other blood-derived product for diabetic chronic wounds/ulcers, using an FDA-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment).

• HCPCS G0460 – non-diabetic chronic wounds

Autologous platelet-rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration, and dressings, per treatment

Diagnoses Codes

ActiGraft^Pro system requires two diagnosis codes 

For claims with dates of service on or after July 1, 2023, PRP, for the treatment of chronic non-healing diabetic wounds must be billed reporting both an ICD-10 diagnosis code for diabetes mellitus and an ICD-10 diagnosis code for chronic ulcers.

• Diabetic Mellitus ICD-10-E
• Chronic Ulcers ICD-10-L

*Disclaimer: The information provided shall not be constructed as a statement, promise, or guarantee that reimbursement will be received. Reimbursement requirements are subject to change at any time. Check with your local payer regularly.

NCD 270.3 coverage applies to the following site of service:

• POS 11 – Office
• POS 19 – Off-campus hospital outpatient
• POS 22 – On-campus hospital outpatient
• POS 49 – Independent clinic
• POS 12 – Home/private residence
• POS 31 – Skilled Nursing

Disclaimer: MPFS payment applicable to Part B Patient

Hospital Outpatient Wound Centers-19 & 22

Independent Wound Care Clinics -49

Private Practice- 11

Home -12

Skilled Nursing-31