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Recombinant and Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non-Orthopedic Conditions
Blue Cross & Blue Shield of Mississippi·MS · Wound Care, General Surgery, Plastic Surgery +4 more·Medical Policy
We identified it
Aug 22, 2026
Summary
This policy clarifies that platelet-rich plasma (PRP) and recombinant platelet-derived growth factors for non-orthopedic wound healing and other non-orthopedic conditions are classified as investigational and not covered. The policy explicitly excludes orthopedic applications, which are addressed in a separate policy. Billing teams must ensure claims for PRP wound treatment are denied as investigational unless they fall under specific medically necessary indications (which are not detailed in this excerpt).
Action Required
Immediately: Billing team must update claim denial rules in billing software to classify PRP for non-orthopedic wound healing as investigational (not covered). Configure system to automatically deny claims for HCPCS codes S0157 and S9055 when submitted for wound healing or non-orthopedic indications. Update denial templates to cite policy A.2.01.16 as the reason for rejection. Communicate to providers and clinical staff that PRP requests for acute/chronic wounds, surgical wounds, and non-healing ulcers require prior authorization review or will be denied as investigational. Verify all existing PRP wound-related claims in accounts receivable and resubmit only those meeting any covered exceptions (if documented in full policy). Reference the separate 'Orthopedic Applications of Platelet-Rich Plasma' policy for orthopedic-related PRP claims to avoid incorrect denials.