Does Medicare Cover PRP Injections?

Does Medicare Cover PRP Injections

Platelet-rich plasma (or PRP for short) injections are a fairly new form of therapy. This treatment aims to stimulate healing.

People can get PRP injections to help heal joints, muscles, tendons, ligaments and skin. Because doctors use it to treat conditions like arthritis, tendinitis, joint injuries and even hair loss, they are becoming a more popular treatment option for many. This includes seniors who suffer from some of these conditions.

So a common question many people have is, “Does Medicare cover PRP Injections?” In this article, we answer that question in clear, plain English. You will also find the average costs of PRP injections and other helpful info.

Does Medicare Cover PRP Injections?

The short answer is no. In most cases, Medicare will not cover the cost of PRP injections. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your PRP injections.

Original Medicare (Medicare Part A and Part B) usually does not provide coverage for PRP injections. So that means you will have to pay 100 percent of the costs for your PRP injections.

The reason why Medicare does not provide coverage for PRP injections is there currently is not enough scientific evidence to prove how effective they are.

That said, in some cases, Original Medicare may provide coverage for your PRP injections. Original Medicare may cover PRP injections if you have “chronic non-healing diabetic, pressure, and/or venous wounds”. In addition, according to the Centers for Medicare and Medicaid Service, the following conditions must also be met in order to get coverage:

If you are a part of a clinical research study “that addresses the following questions using validated and reliable methods of evaluation”.
Clinical study applications for coverage under this National Coverage Determination (NCD) must be approved by August 2, 2014.

You can learn more about these requirements on the CMS website.

Just like with Original Medicare, Medicare Advantage plans (Medicare Part C) may also provide coverage for PRP injections if you meet the above conditions. Medicare Advantage must provide coverage for everything Original Medicare covers. However these plans offer some additional benefits as well. You will need to check with your plan to see if they may provide coverage for PRP injections Original Medicare does not cover.

How Much Do PRP Injections Cost?

The average costs of PRP injections range from around $500 to $2,500 or more. Figure the most common costs will fall between $1,000 and $2,000. This is per treatment. Multiple treatments may be necessary which will obviously increase your costs.

However, the exact costs of PRP injections may vary depending on several factors. Some of those factors may include your location and the type of facility you go to. Another factor that may affect the costs of your PRP injections is the type of medical professional who will administer them.

How Do PRP Injections Work?

Platelets are a type of blood cell. One that plays a key role in healing wounds. Two main things they do are to form clots (to help stop bleeding) and support the growth of new cells.

For a PRP injection, a sample of blood is put in a centrifuge to separate it out into different parts. One of which is PRP. The idea behind PRP injections administration is that, once the PRP is injected into the damaged tissues, it will stimulate the body to grow new and healthy cells and promote healing.

Because the treatment uses platelets from your own body, usually there are not any side effects to these injections. You can pretty much go about your day right after getting one.

Medicare is looking at evidence for the effectiveness of PRP injections for a number of conditions including:

Tennis Elbow
Carpal Tunnel Syndrome
Rotator Cuff Tears
Plantar Fasciitis
Achilles Tendinopathy
Patellar Tendinopathy
Osteoarthritis
Chronic Low Back Pain

While Medicare describes the evidence is “promising” they believe there is not currently enough high-quality evidence to justify the use of PRP outside clinical trials. For now that means Medicare does not pay for PRP treatments.

So far, these injections only have approval from the US Food and Drug Administration (FDA) for use in bone graft treatments. While doctors use these injections to treat a number of other conditions as we describe above, these treatments have not yet gotten FDA approval.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.