Key Takeaways
- Medicare does not cover platelet-rich plasma (PRP) injections for any health condition.
- Medicare does not cover experimental treatments, including PRP injections, because currently, there is not enough research confirming their efficacy.
- TRICARE previously offered some PRP injection coverage, but this ended in September 2024.
Medicare previously provided some coverage for some participants in clinical trials that tested the effectiveness of PRP injections for chronic non-healing diabetes-related, pressure, and/or venous wounds. However, it only provided coverage for participants who applied for coverage for clinical trials before August 2, 2014.
Keep reading to learn why Medicare does not cover PRP injections and what you can expect to pay for PRP injections if you choose to get them and pay out of pocket.
Medicare only covers medically necessary treatments.
Medicare does not cover experimental treatments, including PRP injections.
That’s because research on the effectiveness of PRP injections does not suggest they are beneficial.
A 2023 review of studies explains that most research has focused on PRP injections for certain health conditions, including:
- knee osteoarthritis, with limited research on osteoarthritis in the shoulder, elbow, foot, and ankle
- carpal tunnel syndrome
- tennis elbow (lateral epicondylitis)
However, while test-tube studies suggest a possible benefit of PRP injections, studies in humans comparing PRP with traditional treatments have been mixed. More research is still needed.
Researchers also determined that, with the number of injections needed over time, the total healthcare cost was around $26,619.
Compared with total knee arthroplasty, a traditional treatment for knee osteoarthritis, researchers found that PRP injections:
- were more expensive
- took longer to have an effect
- had benefits that did not last as long
Other
Most other insurance providers do not cover PRP injections.
The exception was TRICARE, a government-provided health insurance for active-duty military service members. But its provisional coverage ended in 2024.
TRICARE covered PRP injections from October 1, 2019, until September 2024, but only if you met certain criteria, which included:
- a diagnosis of mild to moderate chronic knee osteoarthritis
- a diagnosis of lateral epicondylitis, also known as “tennis elbow”
- additional unspecified criteria
Medicare does not cover PRP injections because it only covers treatments that have been determined to be effective through research. Medicare considers PRP an experimental treatment, as researchers are still standardizing and investigating its possible benefits.
Most other insurance providers do not cover PRP injections.
However, refinement of the PRP injection protocol and additional clinical trials could possibly cause the coverage decision to be reevaluated sometime in the future.