Medical Policy: 02.01.32 

Original Effective Date: August 2007 

Reviewed: January 2018 

Revised: January 2018 

 

Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

 

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.

 

Description:

Platelet - Rich Plasma (PRP) 

The use of platelet-rich plasma (PRP), an autologous growth factor has been proposed as a treatment for various musculoskeletal conditions and as an adjunctive procedure in orthopedic surgeries. The potential benefit of PRP has received considerable interest due to the appeal of a simple, safe, low cost, and minimally invasive method of applying growth factors.

 

Autologous platelet-derived growth factors (APDGF) also referred to as platelet-rich plasma (PRP),  have been proposed for the treatment of multiple orthopedic indications including but not limited to the following: degenerative cartilage lesions; tendonitis; joint capsular injuries; plantar fasciitis; soft tissue trauma (e.g. tendon and ligament ruptures); fractures; osteoarthritis of the knee, hip and shoulder; and muscle injuries and disorders to enhance healing. 

 

Autologous platelets are a rich source of platelet-derived growth factor that function as a transforming growth factor as a mitogen (agent) for fibroblasts, smooth muscle cells, osteoblasts, and vascular endothelial growth factors. Autologous platelet concentrate suspended in plasma, platelet-rich plasma (PRP), can be prepared from samples of centrifuged autologous blood. Exposure to a solution of thrombin and calcium chloride degranulates platelets, releasing the various growth factors. Each growth factor released has a specific role in the cellular process that promotes healing and tissue growth. 

 

Platelet-rich plasma (PRP), is extracted from a small quantity of blood collected from the patient using a standard peripheral vein puncture procedure followed by simple centrifuge to remove most of the larger cells (white and red blood cells) and the majority of the fluid, and concentrate the platelets in a small volume of plasma (the liquid component of the blood) that is platelet-rich. The concentration of platelets and, thereby, the concentration of growth factors can be 5 to 10 times greater or richer than usual. 

 

Although it is not exactly clear how PRP works, many experts have speculated that chronic, painful, degenerative conditions of the connective tissues, such as tendinopathies and osteoarthritis, are the result of failed or inadequate healing responses to repeated subacute injuries. Because connective tissues often have limited blood circulation, they have only a limited innate ability to repair the damages of daily wear and tear. Thus, if such damage regularly exceeds the daily repair capacity, the damage will slowly accumulate until the tissue function becomes impaired. Because the tissues do not suffer an acute insult, the acute healing pathways are not triggered to assist in healing the accumulated damage. Therefore, practitioners speculate that if the acute healing pathways can be activated, the body can be induced to repair the damage. Injection of PRP into the injury site is thought to stimulate an acute injury and may induce an acute healing process.

 

Platelet Rich Plasma in Surgical Procedures

Platelet-rich plasma (PRP) may also be used during certain types of surgery for some injuries including Achilles tendon rupture, rotator cuff repair, anterior cruciate ligament (ACL) reconstruction, articular cartilage repair, long bone healing and nonunion repair. Non orthopedic indications include wound care, plastic surgery, trauma surgery and general surgery. This is done by preparing the PRP in a special way, the polymerization of fibrin from fibrinogen creates a platelet gel (platelet rich fibrin matrix), which can then be used as an adjunct to surgery with the intent of promoting hemostasis and accelerating healing.  Based on review of the literature several systematic reviews reported that the available evidence was poor or limited in the number of studies. Better quality randomized controlled trials are needed to determine the actual benefit of PRP for these surgical applications in which it has been used. Based on study results thus far little or no benefit has been seen when PRP is used in these types of surgical procedures.  

 

Summary

Based on review of the peer reviewed medical literature regarding platelet-rich plasma, an autologous platelet-derived growth factor (APDGF), there have been a number of studies looking at whether platelet-rich plasma is effective for conditions affecting bones, muscles, ligaments and other tissues. The potential benefit of PRP has received considerable interest due to the appeal of a simple, safe, low-cost and minimally invasive method of applying growth factors.  However, current results of PRP trials are mixed and studies are limited in both size and quality. A systemic review found that a greater portion of the studies reported no benefit from PRP than studies that reported a benefit. It is unknown if the mixed results are due to variability in the conditions studied and outcomes measured, to differences in platelet separation technique, concentration or activation, or to differences in the timing and frequency of administration. Additional studies are needed to resolve these issues. The evidence is insufficient to determine the effects of the technology on net health outcomes. 

 

Autologous Protein Solution 

Osteoarthritis is a common degenerative disease characterized by chronic pain, joint stiffness, reduced function, cartilage degradation, loss of subchondral bone and synovial inflammation. Although symptoms may be alleviated with conservative therapies such as analgesic drugs, lifestyle modifications, and physical therapy, no disease modifying treatment is currently available. New approaches may allow for earlier intervention than joint replacement, autologous protein solution (APS) is a new therapy under investigation for the treatment of osteoarthritis of the knee.

  

One mechanism of osteoarthritis progression is a degenerative feed-forward cycle caused by pathological increases in inflammatory cytokines and catabolic factors within and adjacent to the synovial space. Inflammatory and catabolic proteins such as interleukin-1 beta, tumor necrosis factor, and matrix metalloproteinase, have been implicated in cartilage degradation and continued osteoarthritis progression. It has been proposed that approaches to block these deleterious proteins could improve patients’ symptoms and perhaps the progression of the disease may be halted or even reversed.

 

Autologous protein solution (APS) is an autologous blood derived therapy composed of concentrated white blood cells (WBCs), platelets and plasma to contain high concentrations of anti-inflammatory cytokines and anabolic growth factors. White blood cells are the main source of interleukin-1 receptor antagonist in the body which competitively inhibits inflammatory interleukin-1B signaling. Platelets alpha granules contain anabolic growth factors which are important in cartilage repair pathways and synergistically act with anti-inflammatory cytokines on the nuclear factor kappa-light chain enhancer of activated B-cells pathway. Plasma contains anti-inflammatory cytokines including soluble interleukin-1 receptor antagonist-type II and soluble tumor necrosis factor receptor type 1 and type II. The ability of APS to block both interleukin-1B and tumor necrosis factor signaling pathways suggest it may have utility in the treatment of osteoarthritis by blocking the effects of inflammation in chondrocytes, macrophages and cartilage explants.

 

A small amount of blood is drawn from the patient, autologous protein solution (APS) kits have been developed to process the autologous blood to produce the high concentrations of anti-inflammatory cytokines (proteins) and anabolic growth factors. The APS kit aids separation and concentration of the patient’s blood components through the use of centrifuge. The kit permits autologous protein solution to be prepared at the point of care.  The kit includes blood processing devices, a cell separator, cell concentrator and a vial of anticoagulant citrate dextrose solution. The use of prepared APS should be used within 4 hours after drawing blood from the patient. The safety and effectiveness of frozen stored APS has not been established. Prior to injecting APS intra-articularly, the physician may remove any synovial fluid or effusion before the injection. APS should be injected into a single anatomical location not partition into multiple injections or injecting at multiple locations. This is given to inhibit inflammation and reduce cartilage degradation.         

 

Based on review of the peer reviewed medical literature, the literature is limited regarding autologous protein solution (APS) for the treatment of osteoarthritis. Current studies may show promise that symptoms were improved, however, based on study results authors have concluded that well controlled, randomized multicenter clinical studies to establish safety and clinical effectiveness is warranted. The evidence is insufficient to determine the effects on net health outcomes.

 

Practice Guidelines and Position Statements 

National Institute for Health and Care Excellence (NICE)

In 2014, NICE issued guidance on the use of platelet rich plasma injections for osteoarthritis of the knee. NICE concluded that the current evidence on platelet-rich plasma injections for osteoarthritis of the knee raises no major safety concerns; however, the evidence on efficacy is inadequate in quality. NICE recommends this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

 

Further research into platelet-rich plasma injections for treating osteoarthritis of the knee should clearly describe patient selection and should take the form of well-designed, controlled studies that compare the procedure against other methods of management. Outcomes should include measures of knee function, patient reported outcome measures and the timing of subsequent interventions. Studies aimed at assessing possible cartilage repair after platelet-rich plasma injections should include detailed radiographic or MRI imaging before and after the procedure.      

 

American Academy of Orthopaedic Surgeons (AAOS)

In 2013, the American Academy of Orthopaedic Surgeons  (AAOS) issued guidance on the treatment of osteoarthritis of the knee, evidence based guideline 2nd edition, which states “were unable to recommend for or against growth factor injections and/or platelet rich plasma for patients with symptomatic osteoarthritis of the knee.”   Recommendation: Inconclusive (there is a lack of compelling evidence that has resulted in an unclear balance between benefits and potential harm).

 

Regulatory Status

Blood products such as platelet rich plasma (PRP) are regulated by the Center for Biologics Evaluation and Research (CBER). CBER is responsible for regulating human cells, tissues, and cellular and tissue based products. The regulation process for these products is described in the U.S. Food and Drug Administration (FDA) 21 CFR 1271 of the Code of Federal Regulations. Under these regulations, certain products including blood products such as PRP are exempt and therefore do not follow the traditional FDA regulatory pathway. To date, FDA has not attempted to regulate activated PRP.

 

Prior Approval:

 

Not applicable

 

Policy:

Platelet - Rich Plasma 

The use of platelet - rich plasma (PRP) is considered investigational for all orthopedic indications including but not limited to the following:

  • Plantar fasciitis
  • Epicondylitis
  • Achilles tendinopathy/Achilles tendon rupture 
  • Dupuytren's  contracture
  • ACL reconstruction
  • Rotator cuff injuries
  • Back and neck pain
  • Osteochondral lesions
  • Osteoarthritis (knee, hip and shoulder)
  • Fractures, including long bone non-union
  • Osteonecrosis of the jaw
  • Soft tissue trauma (e.g. tendon and ligament rupture/tears)
  • Tendonopathies (e.g. elbow, heel, knee, shoulder)
  • Acute joint injuries (sprains/strains)
  • Muscle injuries
  • As a post-surgery supplement

 

Based on review of the peer reviewed medical literature regarding platelet-rich plasma, an autologous platelet-derived growth factors (APDGF), there have been a number of studies looking at whether platelet-rich plasma is effective for conditions affecting bones, muscles, ligaments and other tissues.  The treatment consists of numerous small controlled trials for a wide variety of conditions.  Overall, limitations of the studies include small patient populations, and lack of a control group and/or comparison to standard therapy. Current results of PRP trials are mixed, with some trials reporting improvement with PRP and other trials reporting no improvement. It is unknown if the mixed results are due to variability in the conditions studied and outcomes measured, to differences in platelet separation technique, concentration or activation, or to differences in the timing and frequency of administration. Additional studies are needed to resolve these issues. There is inadequate evidence in the peer reviewed medical literature to support clinical effectiveness and therefore is considered investigational.

 

Autologous Protein Solution 

The use of autologous protein solution (APS) is considered investigational for all orthopedic indications, including but not limited to the treatment of osteoarthritis.

 

Based on review of the peer reviewed medical literature, the literature is limited regarding autologous protein solution (APS) for the treatment of osteoarthritis. Current studies may show promise that symptoms were improved, however, based on study results authors have concluded that well controlled, randomized multicenter clinical studies to establish safety and clinical effectiveness is warranted. The evidence is insufficient to determine the effects on net health outcomes.

 

Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.

  • 0232T Injecton(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed
  • 0481T Injection(s) autologous white blood cell concentrate (autologous protein solution), any site, including image guidance, harvesting and preparation when performed

 

Selected References:

  • Kiter E, Celikbas, E, Akkaya S et al. Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial. J Am Podiatr Med Assoc. 200696(4):293-6.
  • Logan LR, Klamar K, Leon J et al. Autologous blood injection and botulinum toxin for resistant plantar fasciitis accompanied by spasticity. Am J Phys Med Rehabil. 2006;85(8):699-703.
  • Barrett SJ, Erredge SE. Growth factors for chronic plantar fasciitis. Podiatry Today. 2004;17(11):36-42.
  • Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg 2004; 114(6):1502-8.
  • McAleer JP, Kaplan E, Persich G. Efficacy of concentrated autologous platelet-derived growth factors in chronic lower-extremity wounds. J Am Podiatr Med Assoc 2006; 96(6):482-8.
  • Mishra A, Pavelko T. Treatment of Chronic Elbow Tendinosis with Buffered Platelet-Rich Plasma. Am J Sports Med 2006; 34(11):1774-8.
  • Martinez-Zapata MJ, Marti-Carvajal A, Sola I et al. Efficacy and safety of the use of autologous plasma rich in platelets for tissue regeneration: a systematic review. Transfusion 2009; 49(1):44-56.
  • Mishra A, Woodall J Jr, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med 2009; 28(1):113-25.
  • Kon E, Buda R, Filardo G et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2009 Oct 17. [Epub ahead of print]
  • de Vos RJ, Weir A, van Schie HTM et al. Platelet-rich plasma injection for chronic Achilles tendinopathy. A Randomized Controlled Trial. JAMA. 2010; 303(2):144-49.
  • Almdahl SM, Veel T, Halvorsen P et al. Randomized prospective trial of saphenous vein harvest site infection after wound closure with and without topical application of autologous platelet-rich plasma. Eur J Cardiothorac Surg. 2011 Jan;39(1):44-8. Epub 2010 Jul 15.
  • Castillo TN, Pouliot MA, Kim HJ et al. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med. 2011 Feb;39(2):266-71. Epub 2010 Nov 4.
  • Peerbooms JC, Sluimer J, Bruijn DJ et al. Positive effect of an autologous platelet concentrate in laterla epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010 Feb;38(2):255-62.
  • Kazakos K, Lyras DN, Verettas D et al. The use of autologous PRP gel as an aid in the management of acute trauma wounds. Injury. 2009 Aug;40(8):801-5. Epub 2008 Aug 13.
  • Castricini R, Longo UG, De Benedetto M et al. Platelet-rich plasma augmentation for athroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med. 2011 Feb;39(2):258-65. Epub 2010 Dec 15.
  • Margolis DJ, Bartus C, Hoffstad O et al. Effectiveness of recombinant human platelet-derived growth factor for the treatment of diabetic neuropathic foot ulcers. Wound repair Regen 2005; 13(6):531-6.
  • Niezgoda JA, Van Gils CC, Frykberg RG et al. Randomized clinical trial comparing OASIS Wound Matrix to Regranex Gel for diabetic ulcers. Adv Skin Wound Care 2005; 18(5 pt 1):258-66.
  • ECRI. Platelet-derived Growth Factors for Treating Chronic, Nonhealing Wounds. Health Technology Assessment Service. Plymouth Meeting (PA): ECRI Institute 2012 March 20. [Hotline Service].
  • ECRI. Growth Factors for Treating Chronic Plantar Fasciitis. Health Technology Assessment Service. Plymouth Meeting (PA): ECRI Institute 2012 March 20. [Hotline Service].
  • Sheth U, Simunovic N, Klein G, et al. Efficacy or autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am. 2012 Feb 15; 94(4):298-307.
  • Carter MJ, Fylling CP, Parnell LK. Use of platelet rich plasma gel on wound healing: a systematic review and meta-analysis. Eplasty. 2011;11:e38. Epub 2011 Sep 15.
  • Martinez-Zapata MJ et al. Autologous platelet-rich plasma (PRP) for chronic wounds. Cochrane Summaries. 2012 Oct. 17 Accessed [Accessed May 28, 2013]
  • National Institute for Health and Clinical Excellence Autologous blood injection for plantar fasciitis. NICE interventional procedure guidance 437. 2013.
  • American Academy of Orthopaedic Surgeons, clinical practice guideline (CPG) on the treatment osteoarthritis of the knee 2nd Edition May 2013.
  • Agency for Healthcare Research and Quality (AHRQ), Treatment of Pressure Ulcers, AHCPR Clinical Practice Guidelines No. 15, December 1994.
  • National Institute for Health and Clinical Excellence (NICE). Autologous Blood Injection for Tendinopathy, Interventional Procedure Guidance (IPG438), Published January 2013.
  • National Institute for Health and Clinical Excellence (NICE). Platelet-rich Plasma Injections for Osteoarthritis of the Knee, Interventional Procedure Guidance (IPG491), Published May 2014.
  • ECRI. Platelet-rich Plasma Therapy for Osteoarthritis and Acute Joint Injury. Published 11/3/2009, Updated 5/15/2013.
  • ECRI. Autologous Platelet-rich Plasma Therapy for Knee Osteoarthritis, Published 2/13/2013.
  • ECRI. Platelet-rich Plasma Injections for Treating Chronic Tendinopathies. Published 7/23/2012.
  • ECRI. Autologous Blood Injections for Treating Tendinopathies. Published 2/12/2013.
  • ECRI. Guidelines for Using Platelet-rich Plasma in Surgical Procedures. Published 11/11/2015.
  • UpToDate. Overview of Management of Overuse (Chronic) Tendinopathy, Karim Khan, M.D., Alex Scott PhD, RPT. Topic last updated March 2, 2017.
  • UpToDate. Epicondylitis (Tennis and Golf Elbow), Neeru Jayanthi, M.D., Topic last updated March 16, 2017.
  • UpToDate. Investigational Approaches to the Pharmacologic Therapy of Osteoarthritis, Kenneth C. Kalunian, M.D., Topic last updated February 17, 2015.
  • UpToDate. Plantar Fasciitis. Rachelle Buchbinder, MBBS, MSc, PhD, FRCP, Topic last updated October 14, 2016.
  • OrthoInfo. Platelet-Rich Plasma (PRP). Contributed by Frank B. Kelly, M.D., last reviewed September 2011.
  • PubMed. Rabago D, Best TM, et. al. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet –rich plasma, BR J Sports Med 2009 Jul;43(7):471-81
  • PubMed. Creaney L, Wallace A, Curtis M, Connell D, Growth factor-based therapies provided additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections, BR J Sports Med 2011 Sep;45(12):966-71
  • PubMed. Krogh TP, Bartels EM, et. al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials, AM J Sports Med 2013 Jun;41(6):1435-46
  • PubMed. Hoksrud AF, Bahr R. Injectable agents derived from or targeting vascularity: has a clinical acceptance in managing tendon disorders superseded scientific evidence? J Musculoskeletal Neuronal Interact 2011 Jun;11(2):174-84
  • PubMed. Van Ark M, Zwerver J, et. al. Injection treatments for patellar tendinopathy, Br J Sports Med 2011 Oct;45(13):1068-76
  • PubMed. Murphy RJ, Carr AJ, Shoulder Pain, BMJ Clin Evid 2010 Jul;07.1107
  • PubMed. Sadoghi P, Rosso C, et. al. The role of platelets in the treatment of Achilles tendon injuries, J Orthop Res 2013 Jan;31(1):111-8
  • PubMed. Figueroa D, Figueroa F, et. al. Platelet-rich plasma use in anterior cruciate ligament surgery: systemic review of the literature. Arthroscopy 2015 May;31(5):981-8
  • PubMed. Dold AP, Zywiel MG, et. al. Platelet-rich plasma in the management of articular cartilage pathology: a systematic review, Clin J Sport Med 2014 Jan;24(1):31-43
  • PubMed. Liao HT, Marra KG, Rubin JP. Application of platelet-rich plasma and platelet-rich fibrin in fat grafting: basic science and literature review, Tissue Eng Part B Rev 2014 Aug;20(4):267-76
  • PubMed. Vannini F, Di Matteo B, et. al. Platelet-rich Plasma for foot and ankle pathologies: a systematic review, Foot Ankle Surg 2014 Mar20(1)2-9
  • PubMed. Metcalf KB, Mandelbaum BR, Mcllwraith CW. Application of Platelet-Rich Plasma to Disorders of the Knee Joint, Cartilage 2013 Oct;4(4):295-312
  • PubMed. Lenza M, Ferraz Sde B, et. al. Platelet-rich plasma for long bone healing, Einstein (Sao Paulo) 2013 Jan-Mar 11(1):122-7
  • PubMed. Griffin XL, Wallace D, et. al. Platelet rich therapies for long bone healing in adults. Cochrane Database Syst Rev. 2012 Jul 11:7 CD009496
  • PubMed. Sheth U, Simunovic N, et. al. Efficacy of autologous platelet-rich plasma use for orthopaedic indication: a meta-analysis. J Bone Joint Surg Am 2012 Feb 15;94(4):298-307
  • PubMed. Sommeling CE, Heyneman A, et. al. The use of platelet-rich plasma in plastic surgery: a systemic review. J Plast Reconstr Aesthet Surg 2013 Mar 66(3):301-11
  • PubMed. Cai YZ, Zhang C, Lin XJ. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta analysis. J Shoulder Elbow Surg 2015 Dec:24(12):1852-9
  • PubMed. Warth RJ, Doman GJ, et. al. Clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears with ad without platelet-rich product supplementation: a meta-analysis and meta-regression. Arthroscopy 2015 Feb;31(2):306-20
  • PubMed. Yan J, Sun Y, et. al. Can patients get better clinical outcomes by using PRP in rotator cuff repair: a meta-analysis of randomized controlled trials. J Sports med Phys Fitness 2015 Oct 16
  • PubMed. Zhao JG, Zhao L. et. al. Platelet-rich plasma in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. Arthroscopy 2015 Jan;31(1):125-35
  • PubMed. Vavken P, Sadoghi P, et. al. Platelet-Rich Plasma Reduces Retear Rates After Arthroscopic Repair of Small and Medium Sized Rotator Cuff Tears but Is not Cost Effective. Am J Sports Med 2015 Dec;43(12):3071-6
  • Ramos-Torrecillas J, De Luna-Bertos E, et. al. Clinical utility of growth factors and platelet-rich plasma in tissue regeneration: a review, Wounds volume 26 issue 7 July 2014
  • UpToDate. Achilles Tendinopathy and Tendon Rupture. Karen L. Maughan, M.D. Topic last updated February 23, 2017.
  • UpToDate. Biceps Tendinopathy and Tendon Rupture. Stephen M. Simons M.D., FACSM, J Bryan Dixon, M.D. Topic last updated September 26, 2016.
  • UpToDate. Hamstring Muscle and Tendon Injuries. Karl B. Fields M.D., Spencer T Copland M.D., John S. Tipton M.D. Topic last updated September 16, 2016.
  • UpToDate. Investigational Approaches to the Management of Osteoarthritis. Shirley Yu, BSc (Med), MBBS, MPH, FRACP. Topic last updated January 17, 2017.
  • O’Shaughnessey K, Matuska A, Hoeppner J, et. al. An autologous protein solution prepared from the blood of osteoarthritic patients contains and enhanced profile of anti-inflammatory cytokines and anabolic growth factors. J Orthop Res 2014 October; 32(10): 1349-1355
  • King W, van der Weegen W, Van Drumpt R, et. al. White blood cell concentration correlates with increased concentrations of IL-1ra and improvement in WOMAC pain scores in an open-label safety study of autologous protein solution. Journal of Experimental Orthopaedics 2016 3:9
  • van Drumpt, van der Weegen W, King W, et. al. Safety and treatment effectivenss of a single autologous protein solution injection in patients with knee osteoarthritis. BioResearch Open Access Volume 5.1, 2016
  • Zimmerbiomet nSTRIDEtrial.
  • UpToDate. Adductor Muscle and Tendon Injury. Jon Patricios MBBCh, MMedsci, FACSM, FFSEM (UK). Topic last updated May 3, 2017.
  • UpToDate. Intraarticular and soft tissue injection: what agent(s) to inject and how frequently. W. Neal Roberts Jr. M.D. Topic last updated November 29, 2017.
  • UpToDate. Management of knee osteoarthritis. Leticia Alle Deveza M.D., Kim Bennell M.D., Topic last updated June 28, 2017.     

 

Policy History:

  • January 2018 - Annual Review, Policy Revised
  • January 2017 - Annual Review, Policy Revised
  • January 2016 - Annual Review, Policy Revised
  • February 2015 - Annual Review, Policy Revised
  • April 2014 - Annual Review, Policy Revised
  • May 2013 - Annual Review, Policy Revised
  • May 2012 - Annual Review, Policy Renewed
  • August 2011 - Annual Review, Policy Renewed

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

 

*CPT® is a registered trademark of the American Medical Association.