How To Use HCPCS Code G0465

HCPCS code G0465 describes the use of autologous platelet-rich plasma (PRP) or other blood-derived products for the treatment of diabetic chronic wounds and ulcers. This code encompasses the entire process of administering PRP or blood-derived products, including the necessary preparatory procedures, dressings, phlebotomy, centrifugation or mixing, and other associated services.

1. What is HCPCS G0465?

HCPCS code G0465 is specifically used to identify the utilization of autologous platelet-rich plasma (PRP) or other blood-derived products for the treatment of diabetic chronic wounds and ulcers. It is important to note that this code can only be used when an FDA-cleared device is employed for this indication.

2. Official Description

The official description of HCPCS code G0465 is “Autologous platelet-rich plasma (PRP) or other blood-derived product for diabetic chronic wounds/ulcers, using an FDA-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment).” The short description for this code is “Autolog PRP diab wound ulcer.”

3. Procedure

1. The procedure for HCPCS code G0465 involves the collection of autologous blood from the patient.
2. The collected blood is then processed using an FDA-cleared device, such as a centrifuge, to separate the platelet-rich plasma.
3. The platelet-rich plasma is then administered to the diabetic chronic wound or ulcer, either through direct application or injection.
4. Dressings may be applied to the treated area to protect and promote healing.
5. Additional preparatory procedures, such as phlebotomy and mixing, may be performed as necessary.

4. When to use HCPCS code G0465

HCPCS code G0465 should be used when healthcare providers are utilizing autologous platelet-rich plasma (PRP) or other blood-derived products for the treatment of diabetic chronic wounds and ulcers. It is important to ensure that an FDA-cleared device is being used for this specific indication. This code is not applicable for other wound or ulcer treatments that do not involve the use of PRP or blood-derived products.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0465, healthcare providers need to document the following:

• Medical necessity for the use of autologous platelet-rich plasma (PRP) or other blood-derived products for the treatment of diabetic chronic wounds and ulcers.
• Documentation of the specific preparatory procedures performed, such as phlebotomy, centrifugation, or mixing.
• Details of the administration process, including the method of application or injection.
• Any additional services provided, such as dressings or other wound care.

6. Historical Information and Code Maintenance

HCPCS code G0465 was added to the Healthcare Common Procedure Coding System on April 13, 2021. It has an effective date of July 01, 2023. As of now, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage and pricing for HCPCS code G0465 may vary depending on the carrier and insurance policies. The pricing indicator code for this code is 13, which means the price is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS is priced under one methodology. It is important to check with Medicare or other insurance providers to determine the specific coverage and reimbursement policies for this code.

8. Examples

Here are five examples of when HCPCS code G0465 should be billed:

1. A patient with diabetes presents with a chronic non-healing wound on their foot. The healthcare provider collects autologous blood, processes it using an FDA-cleared device, and administers the platelet-rich plasma to the wound site.
2. A diabetic patient with an ulcer on their leg undergoes the same procedure as described in example 1, utilizing autologous platelet-rich plasma for the treatment.
3. A healthcare provider performs the necessary preparatory procedures, including phlebotomy and centrifugation, and administers autologous platelet-rich plasma to a chronic wound on a patient’s arm.
4. A diabetic patient with multiple chronic wounds receives treatment using autologous platelet-rich plasma. The healthcare provider performs the necessary preparatory procedures and administers the PRP to each wound site.
5. A patient with a diabetic chronic wound on their abdomen undergoes the entire process of autologous platelet-rich plasma treatment, including preparatory procedures, administration, and dressing application.