April 7, 2022
Our sports medicine physician is planning to perform a Prolotherapy procedure on a patient who has tendinitis. The physician would like to know what CPT code to report.
There is no Category I or Category III CPT code for Prolotherapy; however there is a HCPCS code M0076. Medicare does not recognize HCPCS codes in the “M” range; other payors may or may not recognize these codes.
Many payors consider this procedure investigational and may not cover the service.
KZA recommends reporting an unlisted code if you submit this to the payor and M0076 is not recognized by the payor. If this is not submitted to the payor, M0076 may be entered internally for tracking purposes.
A possible comparison code for this procedure is 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)).
*This response is based on the best information available as of 04/07/22.