All PlansCoverageMedium impact
07.07.09j, Stem-Cell Therapy/Platelet-Rich Plasma for Orthopedic Applications and Platelet-Rich Plasma/Platelet-Derived Growth Factor for Wound Healing and Other Miscellaneous Non-Orthopedic Conditions
Independence Blue Cross·Orthopedics, Wound Care, General Surgery +1 more·Medical Policy
Effective date
Mar 5, 2025
We identified it
Jun 19, 2026
Summary
This is a reissued medical policy (effective 03/05/2025) governing coverage and billing for stem-cell therapy, platelet-rich plasma (PRP), and platelet-derived growth factor (PDGF) treatments across orthopedic and non-orthopedic applications. The billing team must review the full policy text to identify specific coverage criteria, prior authorization requirements, and affected procedure codes to ensure compliant claim submission.
Action Required
By 03/05/2025: Billing team must obtain and review the complete policy text at the provided URL to identify: (1) specific CPT/HCPCS codes covered for stem-cell therapy and PRP/PDGF procedures, (2) prior authorization requirements and submission procedures, (3) documentation requirements for medical necessity, and (4) any exclusions or limitations by diagnosis or condition. Update billing system rules, encounter forms, and provider education materials accordingly. Ensure all claims for stem-cell and PRP/PDGF therapies submitted on or after 03/05/2025 comply with updated coverage criteria. Claims submitted without compliance may be denied.