Medicare only covers PRP injections for the treatment of nonhealing diabetic wounds, and the treatment must meet specific criteria.
Platelet-rich plasma (PRP) therapy is a controversial therapy that involves using a person’s blood to help heal tissue injuries. A PRP injection contains blood plasma and platelets with proteins that help repair and regenerate tissues.
Healthcare professionals may recommend PRP injections to help treat certain tissue injuries and degenerative bone conditions.
However, since very little research exists into the effectiveness of PRP treatment for these conditions, Medicare and most private health insurers do not cover the costs.
The Centers for Medicare and Medicaid Services (CMS) states that Medicare will cover PRP injections to help treat chronic, nonhealing diabetic wounds, such as diabetic ulcers.
However, Medicare will only cover the treatment for up to 20 weeks. Additionally, the coverage requires healthcare professionals to prepare the PRP using equipment and technologies that have received approval from the Food and Drug Administration (FDA).
For a person to receive coverage for a particular treatment, the CMS must deem the treatment medically reasonable and necessary. With this in mind, the CMS states that there is currently insufficient evidence to support the use of PRP for the following injuries and conditions:
- tendinopathies and non-tendon inflammation
- lateral epicondylitis, or tennis elbow
- carpal tunnel syndrome
- rotator cuff tears
- plantar fasciitis
- Achilles tendinopathy
- patellar tendinopathy
- osteoarthritis
- chronic low back pain
Why does Medicare not cover PRP treatment for other types of tissue injury?
So far, research into PRP’s effectiveness for conditions other than nonhealing diabetic wounds has yielded conflicting results. In many cases, this has been due to issues with study design, such as:
- small sample sizes
- short follow-up durations
- differences in PRP preparation, administration, and dosages between studies
- large differences in the time between individual PRP treatments between studies
- inclusion of data from studies other than randomized controlled trials (RCTs)
- potential experimenter bias, or lack of blinding
However, researchers continue to study PRP’s effectiveness using high quality, large-scale RCTs. The CMS will reassess its decision to use PRP for these conditions in light of new robust evidence.
Coverage limitations
At present, Medicare will only cover PRP for the treatment of chronic, nonhealing diabetic wounds.
Importantly, Medicare will only provide coverage for PRP for up to 20 weeks. A person needs to receive the injections through a healthcare professional who uses FDA-approved equipment and technologies to prepare the PRP.
The CMS does not list the Medicare coverage costs for PRP injections to treat nonhealing diabetic wounds. People who require the injections can ask a doctor or healthcare professional for information on the coverage costs.
A 2020 review notes that, in certain circumstances, the CMS may consider covering PRP injections that someone receives as part of a clinical trial. As such, people may want to speak with a doctor about the possibility of taking part in these research studies.
According to a 2018 review, the cost of a single PRP treatment ranges from around $500 to $2,500. However, these costs can add up as most people return for repeat treatments.
Below are some answers to frequently asked questions about PRP injections.
Does Medicare cover PRP injections for arthritis?
The CMS states that Medicare does not cover PRP injections for osteoarthritis (OA). The agency explains that the current scientific evidence is insufficient to determine the effectiveness of PRP for this condition.
Does Medicare cover PRP injections for a torn rotator cuff?
The CMS states that Medicare does not cover PRP injections for a torn rotator cuff, as research into the use of PRP for this condition has so far yielded conflicting results.
Platelet-rich plasma (PRP) injections are a type of therapy that may help repair and regenerate damaged tissues.
Currently, Medicare only covers PRP injections for the treatment of nonhealing diabetic wounds and only for up to 20 weeks. Healthcare professionals must prepare the PRP using Food and Drug Administration (FDA)-approved equipment and technologies.
Medicare does not yet cover PRP injections for other types of tissue injury because research into its efficacy is limited.
PRP costs can range from around $500 to $2,500 per treatment, with most people requiring multiple sessions.
