Day 1
Application for Chronic Wounds
Covered by G0465
National Coverage
Our proprietary, patented technology delivers the healing power of advanced biologic products with national coverage from Medicare and Medicare Advantage Plans.
What’s Covered
ActiGraftPRO® system is described by the National Coverage Determination (NCD 270.3) as a blood-derived product and is eligible for reimbursement with HCPCS G0465.
Centers for Medicare & Medicaid Services (CMS) will reimburse autologous PRP for the treatment of chronic non-healing diabetic wounds for a duration of 20 weeks, when prepared by devices whose Food and Drug Administration (FDA)-cleared indications include the management of exuding cutaneous wounds, such as diabetic ulcers.
- The PRP is different from previous products in that it contains whole cells including white cells, red cells, plasma, platelets, fibrin, stem cells, and fibrocyte precursors.
- The PRP is used by physicians in clinical settings in treating chronic, non-healing wounds, cutaneous wounds, soft issue and bone.
Coverage of autologous PRP for the treatment of all other chronic non-healing wounds will be determined by local MACs.
HCPCS Codes
- HCPCS G0460
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
- HCPCS G0465
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).
Diagnoses Codes
ActiGraftPro 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.
The ActiGraft Coverage Support Program
RedDress is committed to physicians and facilities using ActiGraftPro system to benefit their patients. The ActiGraft Coverage Support Program is facilitated by PRIA Healthcare, an experienced third-party provider to help expand patient access to the ActiGraft Procedure. They will assist you with all prior authorization, coding, billing, and reimbursement questions.
We are just a phone call away to help you and your patients navigate the insurance coverage process.
+1.860.740.0343
Monday – Friday, 8:00am – 5:00pm CST
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