Platelet Rich Plasma Injections Available under Provisional Coverage Program
Monday, October 28, 2019
TRICARE’s Provisional Coverage Program allows for coverage of emerging treatments and technologies. The newest addition to this program is provisional coverage for platelet rich plasma (PRP) injections for beneficiaries who meet specific clinical requirements. As this is a limited benefit, prior authorization is required. Health Net Federal Services, LLC (HNFS) offers a PRP Letter of Attestation to attach to your authorization request in lieu of medical documentation.
TRICARE offers provisional coverage of PRP injections to beneficiaries who have been diagnosed with mild to moderate chronic osteoarthritis of the knee or lateral epicondylitis, where conservative treatment such as physical therapy, diet and exercise was unsuccessful after three months or contraindicated.
If you have patients who do not meet this criteria but may benefit from PRP injections, submit an authorization request with a completed PRP Letter of Attestation to HNFS for review.
Find details on submitting authorizations to HNFS on our How to Submit page. Learn more about TRICARE’s Provisional Coverage Program in the TRICARE Policy Manual, Chapter 13, Section 1.1.