Prp

[murphles]

PRP
My practice has asked me to integrate PRP into my practice.
Who of you are doing this? What is your set up. What body parts... Are you using ultrasound and do you need it really with these injections on low body weight athletes? Obviously anatomic localization not too hard on these folks but what is your experience. PM me regarding billing. We are not looking at this as a big profit center but rather to offer a service to our sports patients rather than being sent out. Interestingly who draws the blood is a barrier. Obviously I could do it but they pay me a lot to be drawing blood.

---

Members don't see this ad.

 

[lobelsteve]

PRP is as much about the "sales" atittude as the cocktail injected.

Still voodoo science. Hopefully someone other than a guy trying to sell me a secret recipe and a mixer can publish data, postulate and prove a MOA, and have it repeated.

It still bills as a trigger point, no?

 

[PMR 4 MSK]

It still bills as a trigger point, no?

It has a temporary code 023T2, so virtually no one will pay it, except maybe work comp. Have anyone who undergoes it sign an ABN.

We have a couple nurses who can draw the blood.

I would look at getting payment up front for most people, as once they are out the door and insurance denies payment, your odds of getting paid go way down.

 

[olafa]

what codes do you use for WC to get it covered??

 

[j4pac]

It's largely a cash pay business as insurance companies are unwilling to pay the bill (and why should they? the literature on it sucks right now). If I was in practice, I'd market it for what it is...a treatment that may or may not help patients who have failed other treatment options (or unwilling to go under the knife) with the understanding that it is NOT a cure and at most may help with pain relief.

I think that you may be able to market yourself better as someone who can perform ultrasound guided injections because even if you can't guarantee that PRP (or stem-cell treatments for that matter) will work, at least you can tell your patient that the PRP is going in the right place.

 

[nvrsumr]

.

 

[painfree23]

What's the reasonable cash pay option price for you offering this in the clinic? Also, I didn't do much in training, but I've done plenty of joint injections under image guidance...instead of steroid, inject the prp. Is there more to it? Do u do it on particular patients? Knees? Hips? Please forgive my ignorance, not trying to be condescending to those who do it, just trying to learn.

 

[Doctor Christmas]

What's the reasonable cash pay option price for you offering this in the clinic? Also, I didn't do much in training, but I've done plenty of joint injections under image guidance...instead of steroid, inject the prp. Is there more to it? Do u do it on particular patients? Knees? Hips? Please forgive my ignorance, not trying to be condescending to those who do it, just trying to learn.

In our sports medicine rotation, several of the attendings do PRP - it's entirely, 100% cash based. The patients pay upfront. They typically have a cost of $500 for regular small volume injections, $2,000 for large volume ones, and $5,000 for the platinum deal where they do the stem cells that are injected. For that they liposuct the patient (one of the palstic surgeons does this) and injet the stem cells. Few people ever get the $5,000 one, but I've seen several people a week (maybe 2-3) get the small volume one and a few get the large volume one. They do knees exclusively for PRP, under US for sure. I don't think I would try PRP for other joints 0 there is no good literature for PRP to begin with, so I think it would be problematic to try to do joints other than knees. There is also an upfront schpill where patients are told that there are no guarantees - some patients are very happy others are not and don't do it again.

 

[painfree23]

In our sports medicine rotation, several of the attendings do PRP - it's entirely, 100% cash based. The patients pay upfront. They typically have a cost of $500 for regular small volume injections, $2,000 for large volume ones, and $5,000 for the platinum deal where they do the stem cells that are injected. For that they liposuct the patient (one of the palstic surgeons does this) and injet the stem cells. Few people ever get the $5,000 one, but I've seen several people a week (maybe 2-3) get the small volume one and a few get the large volume one. They do knees exclusively for PRP, under US for sure. I don't think I would try PRP for other joints 0 there is no good literature for PRP to begin with, so I think it would be problematic to try to do joints other than knees. There is also an upfront schpill where patients are told that there are no guarantees - some patients are very happy others are not and don't do it again.

Thanks for the response. So $500 for one knee? From what I've heard, the kits themselves cost $300-400, so you barely break even. Also, what are your thoughts about doing them under fluoroscopy instead of u/s?

 

[PMR2008]

Thanks for the response. So $500 for one knee? From what I've heard, the kits themselves cost $300-400, so you barely break even. Also, what are your thoughts about doing them under fluoroscopy instead of u/s?

You can get kits for $59 now. Some docs I know spin there own PRP and for what they have told me it costs them less than $5. I still use kits and they go for $250-$300 depending on volume. I like the product I use and have used it for 5 years with good results. I don't offer PRP to everyone and actually say no to a lot of people who come to see me just for PRP. You have to be selective with the type of patient and injury otherwise you are bound to see poor results. Most of the patients I do PRP on are word of mouth or repeat injections for another complaint of joint.

 

[Doctor Christmas]

Thanks for the response. So $500 for one knee? From what I've heard, the kits themselves cost $300-400, so you barely break even. Also, what are your thoughts about doing them under fluoroscopy instead of u/s?

I do not believe that the kits cost the group that much where I've rotated. They essentially draw the patient's blood, centrifugre it in their own machine, and voila! inject under US. I think it would be frowned upon to inject under fluoro and probably not necessary. You don't need fluoro to inject a knee. Also I doubt that a patient would be willing to pay for fluoro time. Yes, $500 for a knee for the lower end package. I think they do them as a series of 3. It is my understanding that they make a good profit.

 

[oreosandsake]

In our sports medicine rotation, several of the attendings do PRP - it's entirely, 100% cash based. The patients pay upfront. They typically have a cost of $500 for regular small volume injections, $2,000 for large volume ones, and $5,000 for the platinum deal where they do the stem cells that are injected. For that they liposuct the patient (one of the palstic surgeons does this) and injet the stem cells. Few people ever get the $5,000 one, but I've seen several people a week (maybe 2-3) get the small volume one and a few get the large volume one. They do knees exclusively for PRP, under US for sure. I don't think I would try PRP for other joints 0 there is no good literature for PRP to begin with, so I think it would be problematic to try to do joints other than knees. There is also an upfront schpill where patients are told that there are no guarantees - some patients are very happy others are not and don't do it again.

you should let the know the FDA came out with guidance in November essentially putting adipose derived stem cells (if they are actually obtaining them and able to get to them by manipulating the tissue) in a box and you are no longer allowed to do so.

otherwise, if they suck out the fat, and inject the fat (even after centrifigure) it is really a fat graft. you will get hardly any stem cells this way and it is disingenuous. the literature is still emerging. patient selection (not ability to pay for it) should be number 1 driver

 

[Doctor Christmas]

you should let the know the FDA came out with guidance in November essentially putting adipose derived stem cells (if they are actually obtaining them and able to get to them by manipulating the tissue) in a box and you are no longer allowed to do so.

otherwise, if they suck out the fat, and inject the fat (even after centrifigure) it is really a fat graft. you will get hardly any stem cells this way and it is disingenuous. the literature is still emerging. patient selection (not ability to pay for it) should be number 1 driver

Can you elaborate on what you mean by "putting adipose derived stem cells in a box"? I do not know how they do it honestly this is simply what I have seen. I know the group works with a plastics guy and he does the lipo and then they inject - how or what componenet i don't know.

 

[oreosandsake]

Can you elaborate on what you mean by "putting adipose derived stem cells in a box"? I do not know how they do it honestly this is simply what I have seen. I know the group works with a plastics guy and he does the lipo and then they inject - how or what componenet i don't know.

the only way to get the stem cells from the fat is by breaking down the fat, connective tissue etc

the only way to do that (despite marketing by product manufacturers) that has been proven scientifically is with collagenase.

the FDA has defined that once you use collagenase, the product you are left with is a drug. you cannot create your own drugs and inject them into people.

the term they use is "minimal manipulation" for HCT/P

HCT/P = human cell tissue product.

doesn't matter if you are a plastic surgeon. when they, or anyone else, does a fat graft, the fat is not more than "minimal manipulation"

mechanical separation such as centrifuge is still minimal manip, but it does NOT liberate stem cells

 

[Doctor Christmas]

the only way to get the stem cells from the fat is by breaking down the fat, connective tissue etc

the only way to do that (despite marketing by product manufacturers) that has been proven scientifically is with collagenase.

the FDA has defined that once you use collagenase, the product you are left with is a drug. you cannot create your own drugs and inject them into people.

the term they use is "minimal manipulation" for HCT/P

HCT/P = human cell tissue product.

doesn't matter if you are a plastic surgeon. when they, or anyone else, does a fat graft, the fat is not more than "minimal manipulation"

mechanical separation such as centrifuge is still minimal manip, but it does NOT liberate stem cells

Oh interesting. I don't want to speak out of place bc I don't know how they do it - perhaps they do what you mentioned perhaps they don't. I learned something today though that was quite cool.

 

[PMR2008]

I do not believe that the kits cost the group that much where I've rotated. They essentially draw the patient's blood, centrifugre it in their own machine, and voila! inject under US. I think it would be frowned upon to inject under fluoro and probably not necessary. You don't need fluoro to inject a knee. Also I doubt that a patient would be willing to pay for fluoro time. Yes, $500 for a knee for the lower end package. I think they do them as a series of 3. It is my understanding that they make a good profit.

So series of three would mean $1500?
I rarely have to do more than 1 PRP injection. How about your Oreo?

 

[oreosandsake]

So series of three would mean $1500?
I rarely have to do more than 1 PRP injection. How about your Oreo?

folks are either responders or non responders.

patient selection is a big factor.

sometimes people will come back and say, "i'm 50% better! should we repeat? what else do you have?"

decision now is repeat vs bmc. this is all for peripheral joints, msk.

i don't sign anyone up for a series of anything

 

[painfree23]

folks are either responders or non responders.

patient selection is a big factor.

sometimes people will come back and say, "i'm 50% better! should we repeat? what else do you have?"

decision now is repeat vs bmc. this is all for peripheral joints, msk.

i don't sign anyone up for a series of anything

Can u elaborate on
"patient selection is a big factor." ?
I understand managing expectations, what else do u mean?

 

[oreosandsake]

bad protoplasm, fibro, autoimmune disease, diabetic, alcoholic, geriatric, unrealistic expectations, KL4+ OA, full thickness rupture, won't go to PT, etc

 

[painfree23]

bad protoplasm, fibro, autoimmune disease, diabetic, alcoholic, geriatric, unrealistic expectations, KL4+ OA, full thickness rupture, won't go to PT, etc

lol it feels like this is more than 3/4 of my patients

 

[PMR2008]

bad protoplasm, fibro, autoimmune disease, diabetic, alcoholic, geriatric, unrealistic expectations, KL4+ OA, full thickness rupture, won't go to PT, etc

Exactly what I do. I use a checklist. Included in the list for me is smoking, chronic NSAID use, multiple steroid injection, poor dietary habits, obesity etc. I have some patients who have never tried therapy before they come and see me. A lot of them don't need regenerative medicine but accurate diagnosis and guided PT.

 

[oreosandsake]

Exactly what I do. I use a checklist. Included in the list for me is smoking, chronic NSAID use, multiple steroid injection, poor dietary habits, obesity etc. I have some patients who have never tried therapy before they come and see me. A lot of them don't need regenerative medicine but accurate diagnosis and guided PT.

and a lot of them won't benefit from it and I don't take their money.

but, they leave, and respect me for it... and everyone has a nephew, husband, uncle, cousin, wife who might benefit

 

[Doctor Christmas]

Yep this is the typical protocol that they use I believe. Patients don’t have to but I believe this is what is generally offered.

 

[olafa]

You can get kits for $59 now. Some docs I know spin there own PRP and for what they have told me it costs them less than $5. I still use kits and they go for $250-$300 depending on volume. I like the product I use and have used it for 5 years with good results. I don't offer PRP to everyone and actually say no to a lot of people who come to see me just for PRP. You have to be selective with the type of patient and injury otherwise you are bound to see poor results. Most of the patients I do PRP on are word of mouth or repeat injections for another complaint of joint.

What kit do you say is $59 ??? I have not seen a 60cc kit anywhere near that price
It does matter on cell collection, not all centrifuges/kits are not created equal on getting high vol of cells.
See the comparision data on study of emcyte, harvest, arthrex

 

[PMR2008]

Will look for the mailer my clinic received. I use Emcyte.

 

[olafa]

the emcyte kits I have not seen lower than 225 for 60cc

 

[painfree23]

How do you recommend someone start implementing it in practice?

Do I really need a course if I do joint injections under fluro/us all the time?

How much do you typically charge?

 

[TableMD]

Not impressed with PRP. The one, slam dunk outcome I had with it was an ultrasound guided injection into a meniscal cyst and lateral collateral ligament tear in a teen volleyball player. I think it will go away as other techniques replace it. I am a huge fan of TENEX for most tendonopathy.

 

[Doctor Christmas]

Not impressed with PRP. The one, slam dunk outcome I had with it was an ultrasound guided injection into a meniscal cyst and lateral collateral ligament tear in a teen volleyball player. I think it will go away as other techniques replace it. I am a huge fan of TENEX for most tendonopathy.

From a personal perspective of PRP (not for joints but for hair growth), it works great! Love it!