Change to Medical Treatment Rules Affects Compensability of PRP Injections

By Charlie R. Leineweber, Attorney at Law

Platelet-rich plasma (PRP) injections have become an increasingly popular treatment intervention for many providers for non-operative management of joint pain and conditions. The effectiveness of these interventions was historically still under investigation and, as such, for years PRP injections were specifically excluded from compensability per OAR 436-009-0010(12)(i). This is no longer the case thanks to changes to that rule, in effect as of April 1, 2025.

Now, OAR 436-009-0010(12)(i) reads that PRP injections are still excluded, but with certain exceptions. The PRP injections remain officially not compensable, except for non-operative treatment of the following:

(A) Knee: Osteoarthritis pain, chondral surface injury and partial thickness meniscal tears after failure of three months of conservative care, which may include a standard course of physical therapy;

(B) Elbow: Lateral and medial epicondylitis after failure of three months of conservative care, which may include a standard course of physical therapy; or

(C) Shoulder: Tendon, bursa, and muscle injuries, including partial tears and small tears, and adhesive capsulitis after failure of three months of conservative care, which may include a standard course of physical therapy.

The above exceptions now make PRP injections compensable in some of the most common circumstances we see PRP injections being prescribed. With this change, each bill received for these treatments should be closely evaluated to the corresponding chart note and circumstances of the claim to ensure whether any of the above exceptions apply to make the service compensable.

The medical service rules can be tricky and are always changing. Please do not hesitate to contact our office any time with questions.