Does Insurance or Medicare Cover PRP and Stem Cell Therapy?

Is PRP Covered by Insurance?

If you have been told that PRP or Stem Cell Therapy is not covered by your insurance, you are hearing what nearly every policy says. Medicare and the major commercial insurers do not pay for PRP or stem cell injections into a joint, tendon or ligament, and Medicare's national rule covers PRP only for certain chronic wounds.

At PRIME Orthopedics & Regenerative Center, regenerative injections are performed by Dr. Abbasi, who is double board certified in Orthopedic Surgery and Sports Medicine, after a full orthopedic examination.

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How Insurers Decide What to Pay For

Every insurance plan, public or private, pays only for services it considers medically necessary. The answer to whether PRP is covered by insurance comes from the written rules each payer publishes about a given service.

Medicare: Reasonable and Necessary

Medicare pays for items and services that are "reasonable and necessary," the test written into Section 1862(a)(1)(A) of the Social Security Act. Medicare applies that test in two layers:

• National Coverage Determinations (NCDs). An NCD is a rule written by the Centers for Medicare & Medicaid Services (CMS) that binds Medicare everywhere in the country.
• Local Coverage Determinations (LCDs). Where no national rule exists, or where the national rule leaves a question open, the regional Medicare Administrative Contractor (MAC) that processes claims writes its own LCD.

Florida's MAC is First Coast Service Options, which serves Jurisdiction N: Florida, Puerto Rico and the US Virgin Islands. Its LCDs decide many questions for Original Medicare patients in Florida.

Commercial Insurers: Medical Policies

Commercial insurers publish medical policies, also called coverage policies or clinical policy bulletins, that sort a service into one of a few categories: medically necessary, not medically necessary, or "experimental, investigational or unproven." A service in the last category is generally excluded from coverage. The member's own plan document has the final word: Cigna's policies state that "in the event of a conflict, a customer's benefit plan document always supersedes the information in the Coverage Policies."

What a Billing Code Means

PRP injections have their own billing code, CPT 0232T, described as "injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed." It is a Category III code, the temporary set of codes the American Medical Association maintains for emerging technology and procedures. A code lets a service be reported; it does not mean any payer has agreed to pay for it.

Why Insurance Does Not Pay for PRP

Each insurer explains its classification in terms of the published research. A service is classified as investigational when, in the insurer's own review, the published studies do not meet the standard the insurer sets for coverage.

Insurers review these policies on a regular cycle, usually once a year. The PRP policies of Florida Blue, UnitedHealthcare, Cigna and the Federal Employee Program were all reviewed or reissued in 2026, and each keeps PRP outside coverage.

Does Medicare Cover PRP?

Medicare has one national rule on PRP: NCD 270.3, "Blood-Derived Products for Chronic Non-Healing Wounds." Its current version took effect on April 13, 2021, and it says:

• Covered Nationally. PRP made from the patient's own blood is covered for chronic non-healing diabetic wounds for up to 20 weeks, when it is prepared with a device whose FDA clearance includes the management of exuding wounds.
• Not Covered Nationally. PRP applied to a closed surgical incision or to a surgical wound that has reopened is not covered.
• Left to the Regional Contractors. Diabetic wounds beyond 20 weeks and all other chronic non-healing wounds are left to each MAC to decide.

Before 2021, Medicare covered PRP for chronic wounds only for patients enrolled in approved clinical studies. The 2021 revision removed that requirement for diabetic wounds.

NCD 270.3 says nothing about joints or tendons, so in Florida the question falls to First Coast. First Coast LCD L39071, "Platelet Rich Plasma," in effect for services on or after December 12, 2021, states that PRP injections and applications "are considered not medically reasonable and necessary" for any use outside NCD 270.3. Its analysis applies that conclusion to PRP injections, and to PRP combined with stem cells, for musculoskeletal injuries and joint conditions, whether given alone or added to another treatment.

Does Medicare Cover Stem Cell Therapy?

The phrase "stem cell" means two different things in Medicare's rules.

Medicare does cover stem cell transplantation, under NCD 110.23, "Stem Cell Transplantation" (current version effective March 6, 2024). That is a hospital procedure in which blood-forming stem cells are given into a vein, and it is unrelated to an orthopedic injection.

For orthopedic stem cell injections, there is no national rule. Cigna's and Florida Blue's policies both record that no NCD or LCD addresses them, which leaves the general "reasonable and necessary" test, and in Florida two LCDs already apply it:

• Bone Marrow. First Coast's PRP rule, L39071, names PRP combined with stem cells among the uses it considers not reasonable and necessary.
• Umbilical Cord and Placental Tissue. First Coast LCD L39877, "Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound," in effect for services on or after December 1, 2024, is "a non-coverage policy for all amniotic membrane, amniotic fluid or other placental-derived product injections and/or applications" for musculoskeletal injuries and joint conditions. Its definition takes in any product made from amniotic membrane, chorion, placenta, Wharton's jelly (the gel-like tissue inside the umbilical cord) or umbilical cord, and umbilical cord blood. First Coast's billing article A59764 adds that the injection service billed the same day is denied as well.

Contractors elsewhere have the same policy, among them Palmetto (L39128, first in effect April 30, 2023) and Noridian (L39116 and L39118, in effect since November 12, 2023).

Medicare Advantage

A Medicare Advantage plan must cover everything Original Medicare covers and must follow Medicare's NCDs and LCDs, though it can add requirements such as prior authorization. Florida Blue's PRP guideline (reviewed January 22, 2026), for example, applies NCD 270.3 and L39071 to its Medicare Advantage plans. A Medicare Advantage plan in Florida follows the same PRP and placental-product rules as Original Medicare.

What Insurance Companies' PRP Policies Say

Among the insurers below, none currently covers PRP injections for a joint or tendon. Each entry is the insurer's own published policy, with its date.

Florida Blue

• PRP. Medical Coverage Guideline 02-10000-09, "Platelet-Derived Growth Factors and Platelet-Rich Plasma" (reviewed January 22, 2026), states that "use of platelet-rich plasma is considered experimental or investigational for all orthopedic indications."
• Stem Cells. Guideline 02-38240-02, "Orthopedic Applications of Stem-Cell Therapy" (reviewed February 26, 2026), states that "mesenchymal stem-cell therapy is considered experimental or investigational for all orthopedic applications," and applies the same classification to allograft products containing viable stem cells.
• Amniotic Products. Guideline 02-10000-11 (revised October 1, 2026) classifies injections of human amniotic membrane and of human amniotic fluid as experimental or investigational for all indications.

UnitedHealthcare

UnitedHealthcare's commercial policy "Prolotherapy and Platelet Rich Plasma Therapies" (No. 2026T0498CC, effective January 1, 2026) states that PRP is "unproven and not medically necessary for any condition or indication."

Cigna

• PRP. Coverage Policy 0507 (effective October 15, 2026) states that PRP "for ANY condition or indication" is "considered experimental, investigational, or unproven."
• Stem Cells. Coverage Policy 0552, "Stem Cell Therapy for Orthopaedic Applications" (effective December 15, 2025), states that Stem Cell Therapy for orthopedic and musculoskeletal conditions "is considered not medically necessary." Its definition of stem cells includes cells from bone marrow, fat tissue and amniotic membrane.

Aetna

Aetna's Clinical Policy Bulletin 0784, "Blood and Adipose Tissue Derived Products for Selected Indications" (last reviewed November 19, 2025), lists platelet-rich plasma injection "for all indications" as experimental, investigational or unproven. The same bulletin puts bone marrow plasma injections and injections of stem cells derived from bone marrow or fat in that category.

The Federal Employee Program and Anthem

The Blue Cross Blue Shield Federal Employee Program policy 2.01.98 (effective July 1, 2026) states that PRP "is considered investigational for all orthopedic indications." Anthem's policy TRANS.00035 (last reviewed May 14, 2026) states that "use of bone marrow aspirate concentrate (BMAC) is considered investigational and not medically necessary," and classifies PRP and Mesenchymal Stem Cell Therapy the same way.

Gel Shots Are Treated Differently

A gel shot, or hyaluronic acid injection for the knee, is a manufactured product rather than a Regenerative Medicine treatment, and many plans pay for it under conditions. Cortisone Shot, Gel Injection or PRP: How They Differ explains what each injection is.

Medicare Part B covers injectable products given by a provider, and after the Part B deductible the patient generally pays 20 percent of the Medicare-approved amount. The LCDs other contractors have written for gel shots, such as WPS's L39529 (in effect since June 11, 2023) and Palmetto's L39260 (in effect since August 21, 2022), set criteria like these:

• The knee must show X-ray evidence of Osteoarthritis, with pain that limits function.
• At least three months of other treatment, such as Physical Therapy and pain medicines, must come first.
• A steroid injection must have been tried first, or ruled out for the patient.
• A repeat course is paid no sooner than six months after the last, and only with documented improvement from it.
• Only the knee is covered; other joints are not.

According to Florida Blue's policy, First Coast retired its own gel shot LCD, L33767, on April 1, 2023. Aetna's Clinical Policy Bulletin 0179 (last reviewed September 2, 2026) sets similar criteria for its members. Florida Blue's commercial guideline 09-J1000-22 (revised January 1, 2026) takes the other position: since April 1, 2015, it has stated that hyaluronic acid injections into a joint do not meet its definition of medical necessity.

Many plans also apply step therapy, covering a preferred brand first. Florida law (section 627.42393 of the Florida Statutes) lets a member or the member's doctor request an exception to a step-therapy requirement.

Why Someone Else Got Coverage

Patients sometimes hear that a friend's PRP was covered. Several facts explain how that can happen:

• Wounds. Medicare's national rule covers PRP for certain chronic diabetic wounds, so a PRP claim can be paid in wound care.
• Gel Shots. A gel shot can be mistaken for PRP, and gel shots are covered by many plans under criteria.
• A Different Plan. Each plan's own document overrides the insurer's medical policy where the two conflict.
• A Different Region. Original Medicare's local rules differ from one contractor's region to the next.

What Paying Directly Means

Paying directly, sometimes called self-pay, means the patient pays the practice for a treatment, rather than the practice billing an insurance plan for it. At PRIME Orthopedics & Regenerative Center, insurance works this way.

Most PPO plans are accepted for consultations and surgical care. Regenerative injections are paid for directly. Please call the office to confirm what applies to your plan.

For PRP, the practice does not bill any insurance plan. Before the treatment, you sign a notice that your plan will not be billed, and payment is made in advance.

Paying With an HSA or FSA

Money in a Health Savings Account (HSA) or a Flexible Spending Account (FSA) can be spent on qualified medical expenses. The IRS defines those by reference to medical care under section 213(d) of the Internal Revenue Code: amounts paid for the diagnosis, treatment, mitigation or prevention of disease, and generally not cosmetic surgery. IRS Publications 502 and 969 do not name PRP or Stem Cell Therapy. For an FSA, the plan's administrator reviews each claim against that definition; for an HSA, the account holder keeps the records that show an expense qualifies.

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