Insurance Compensation for PRF?

Last Updated: Oct 12, 2017

This is a general question of sharing information about insurance billing for the preparation of PRF. Would anyone with experience share ways of billing for venipuncture and preparation of the PRF to be used in grafting sites? We have traditionally billed dental insurance for a bone graft procedure and not billed for anything else. Apparently there is a way to seek compensation for the actual procedure and the way it is done when PRF is being used?

8 Comments on Insurance Compensation for PRF?

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Cliff Leachman

10/12/2017

Interesting, I bill the patient ~$200, along with the extracton fee, if they are not getting an implant later. Never thought of billing the insurance carrier, waiting to hear others response.

Paul

10/12/2017

Thanks for sharing your approach to this dilemma. Another question arises with your response. If one does a graft of whatever kind and the patient does not do an implant after extraction or many months later, does the bone resorb with the same speed as if we didn't do anything? In the case of the maxillae, does the pneumatization of the sinus occur at the same rate as if nothing was done? I am sure there is an answer to these questions.

Steven Cisternas

10/12/2017

We use the code D4265 biological to aid is soft and Osseous tissue regeneration.

Craig Wright

10/13/2017

I've always assumed that PRF would fall under the heading of "biologic material to aid etc." It doesn't get much more biologic than that!

Connie

10/12/2017

The insurance code is D7921 I believe for collection of autologous blood products. Sometimes it's covered but most times it's not a covered benefit. Hope that helps.

Paul

10/12/2017

EUROPEAN LEGISLATION AFTER SEVERAL YEARS OF WAITING, PRF IS FINALLY ALLOWED IN DENTAL AND STOMATOLOGY SUGERY BY THE HEALTH MINISTRY. This is a copy from an article about new legislation in Europe. Hopefully the US will follow with new ADA codes to allow compensation for the use of PRF. The only way this will be possible is if ADA initiates legislation. As one can see, in Europe the fight was going on for years and we have not even started. Medical insurance has nothing to do with the procedure understandably.

CRS

10/13/2017

If you can simply charge the patient and they pay that is the best way, fee for service best and simplest business model. Why would you want to muddle that with insurance. Best use of time and resources. Let insurance reimburse the patient if the patient wants to submit, but then you may have to waste time writing letters etc and insurance will delay and not pay anyway. Not worth it on a small item.

Manosteel

10/21/2017

We just include prp and prf into the cost of the graft. Its a relatively easy procedure just getting a good IV stick is the key.

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