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. 2020 Feb 6;8(2):2325967119900811.
doi: 10.1177/2325967119900811. eCollection 2020 Feb.

An Analysis of Current Treatment Trends in Platelet-Rich Plasma Therapy in the Medicare Database

Brian C Werner  1 , Jourdan M Cancienne  2 , Robert Browning  2 , Nikhil N Verma  2 , Brian J Cole  2
Affiliations

An Analysis of Current Treatment Trends in Platelet-Rich Plasma Therapy in the Medicare Database

Brian C Werner et al. Orthop J Sports Med. .

Abstract

Background: The use of platelet-rich plasma (PRP) in the Medicare population is not well described.

Purpose: To investigate the national use of PRP among Medicare beneficiaries, including the incidence and conditions for which it was used in both operative and nonoperative settings, and determine charges to Medicare.

Study design: Descriptive epidemiology study.

Methods: The Medicare Standard Analytical Files within the PearlDiver database were queried for PRP injections by use of Current Procedural Terminology (CPT) code 0232T from 2010 to 2014. A search of every associated International Classification of Diseases, 9th Revision, code and CPT code on the day of the injection was performed, and codes were broadly categorized as shoulder, knee, elbow, hip, and foot/ankle. These categories were then subdivided into 2 groups based on whether the injection was performed at the time of surgery or for a nonoperative condition. The patient data were analyzed by demographics and geographic region. In further analysis, the charges sent to Medicare for PRP injections were stratified by year and musculoskeletal site.

Results: A total of 3654 PRP injections were coded for and administered during the study period; 57% of recipients were men and 33% were 65 to 69 years of age. We found that 42% of all PRP injections were administered in the southern geographic region. PRP injections were most commonly associated with shoulder diagnoses, followed closely by the foot and ankle and by the knee. The majority of injections given for shoulder conditions were performed at the time of surgery, whereas the majority of knee conditions treated with PRP were associated with nonoperative treatments. Annual charges to Medicare for PRP injections increased 400%, from $500,000 in 2010 to more than $2 million in 2014.

Conclusion: The use and breadth of PRP therapy have increased substantially in Medicare beneficiaries. Further research is required to obtain a consensus on treatment recommendations for PRP use in this population in addition to strategies to obtain insurance reimbursement.

Keywords: Medicare; charges; platelet-rich plasma.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.C.W. has received educational support from Arthrex and Supreme Orthopaedic Systems and hospitality payments from Arthrex, Integra Lifesciences, and Supreme Orthopaedic Systems. J.M.C. has received educational support from Medacta, Smith & Nephew, and Supreme Orthopaedic Systems. N.N.V. has received consulting fees from Arthrex, Medacta, and Smith & Nephew; speaking fees from Arthrex and Pacira; and royalties from Smith & Nephew. B.J.C. has received royalties from Arthrex and DJO; consulting fees from Acumed, Anika Therapeutics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma, Genzyme, Pacira, Smith & Nephew, Verical, and Zimmer Biomet; speaking fees from Arthrex, Carticept Medical, Lifenet Health, and Pacira; educational support from Medwest; honoraria from Vericel; and hospitality payments from Geistlich Pharma and GE Healthcare. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Trends in platelet-rich plasma (PRP) billing for various musculoskeletal sites in the Medicare database from 2010 to 2014.
Figure 2.
Figure 2.
Total platelet-rich plasma charges for each condition for operative and nonoperative uses in the Medicare database.
Figure 3.
Figure 3.
Evaluation of annual charges sent to Medicare for cumulative platelet-rich plasma injections subdivided by anatomic site.
See this image and copyright information in PMC

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