Does Insurance Cover PRP? A Guide for North Carolina Patients
Platelet‑rich plasma (PRP) therapy has exploded in popularity across North Carolina for joint pain, sports injuries, hair restoration, and skin rejuvenation. It’s natural, uses your own blood, and fits perfectly with a regenerative approach to aging and healing. But there’s one question that almost always comes up first: “Does my insurance cover PRP?”
If you live in or around Raleigh, the short, and honest, answer is: usually not, with a few narrow exceptions. This blog breaks down how insurance companies look at PRP, what Medicare does and doesn’t cover, what you can expect from private insurance in North Carolina, and how to check your own benefits before you book a treatment.
What Is PRP and Why Is Coverage So Confusing?
PRP is created by drawing a small amount of your blood, spinning it in a centrifuge, and concentrating the platelets. Those platelets are rich in growth factors that can support tissue repair and regeneration. Clinically, PRP is used for:
- Joint and tendon pain
- Sports injuries
- Hair restoration
- Under‑eye and facial rejuvenation
- Other regenerative and cosmetic concerns
Because PRP sits at the intersection of regenerative medicine, orthopedics, and aesthetics, it doesn’t fit neatly into existing insurance categories. That’s a big part of why coverage is so inconsistent.
How Medicare Views PRP
Medicare’s position on PRP is very specific:
- Medicare does cover PRP for chronic non‑healing diabetic wounds (and closely related chronic wounds) for a limited period, up to 20 weeks, when prepared with FDA‑cleared devices designed for wound care.
- Medicare does not cover PRP for musculoskeletal conditions or joint problems. There is a national non‑coverage policy for PRP used in joints and soft‑tissue injuries.
So, if you’re a Medicare patient in North Carolina asking about PRP for knee arthritis, tennis elbow, hair loss, or cosmetic facial rejuvenation, you should expect no coverage. If you have a chronic non‑healing diabetic wound, coverage might be possible, but only under very specific criteria and time limits.
How Private Insurance in North Carolina Treats PRP
For most commercial plans (employer‑based or Marketplace) in North Carolina, PRP is still considered “investigational”, “experimental”, or “not medically necessary” for most uses.
Several regional and national policies say:
- Blood‑derived growth factors and PRP are not covered for most musculoskeletal or regenerative indications, outside of limited wound‑healing scenarios.
- Clinics across NC, orthopedic, sports medicine, and regenerative practices, consistently report that PRP is self‑pay for joint and tendon issues.
In practical terms, that means:
- PRP for joint pain, tendon injuries, hair restoration, or aesthetics is almost always out‑of‑pocket.
- Your initial consultation and imaging may still be billed to insurance, but the PRP procedure itself usually is not.
Are There Any Exceptions?
Occasionally, a plan will make a case‑by‑case decision for PRP if:
- It’s being used for a very specific wound‑healing indication that fits their medical policy, or
- The plan follows Medicare’s wound‑care criteria closely.
However, this is rare, and most North Carolina patients seeking PRP for orthopedic, cosmetic, or hair-related reasons should plan as if insurance will not pay.
How To Check Your Insurance For PRP Coverage
Even though coverage is unlikely, it’s still worth doing a quick check so you know exactly where you stand. Here’s a simple process:
1. Review Your Benefits
Log into your insurance portal or look at your Summary of Benefits and Coverage. Search for:
- “Platelet-rich plasma” or “PRP”
- “Blood‑derived growth factors”
- “Regenerative injections”
- “Autologous blood products”
If you don’t see anything, that usually means PRP is either excluded or not specifically addressed, which still tends to translate to no coverage unless your provider can match it to a covered wound‑healing policy.
2. Talk To Your Insurer
Ask member services directly:
- “Does my plan cover platelet‑rich plasma (PRP) injections for [your condition]?”
- “Are there any situations where PRP is covered, such as wound healing?”
- “If coverage is possible, is prior authorization required?”
Take notes on who you spoke with and what they said. It won’t override written policy, but it’s helpful context.
3. Talk To Your Provider’s Office
In many cases, your clinic has already tried to bill PRP to local insurers and knows the answer. Practices that focus on regenerative medicine in Raleigh and the Triangle routinely see that PRP is treated as a self‑pay service, so they structure pricing and financing accordingly.
At JIYA in Raleigh, for example, PRP is part of a broader cosmetic regenerative approach that also includes PRP hair restoration, PRF microneedling, natural fillers, and nanofat hair restoration, treatments that typically fall outside insurance but are tailored to long‑term aesthetic and anti‑aging goals.
Using HSA, FSA, or Financing For PRP
Even when insurance won’t pay for PRP itself, you may have other options:
- Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can sometimes be used to pay for PRP when it’s ordered for a legitimate medical indication. Check your plan’s rules and ask your tax or benefits advisor if you’re unsure.
- Some clinics offer package pricing or payment plans, especially when PRP is used in a series (for hair restoration or joint care).
- Third‑party financing companies may provide low‑ or no‑interest payment options over several months.
If cost is a concern, bring it up early in your consultation so the team can walk you through all available options.
Why PRP is Still Considered “Self‑Pay” By Most Insurers
Insurers tend to lag behind clinical practice. In the case of PRP:
- Evidence is promising for some uses (like certain tendon injuries and osteoarthritis), but still evolving.
- There’s no single standardized protocol, doses, frequency, and preparation methods can vary widely.
- Many uses are elective and cosmetic, such as hair restoration and facial rejuvenation, which insurers almost always classify as non‑essential.
Until more long‑term, large‑scale studies are completed and professional societies issue stronger, uniform guidelines, insurers are likely to continue treating PRP as experimental or elective for most indications.
PRP in Raleigh: What To Expect As a Patient
If you’re exploring PRP in the Raleigh area, here’s the typical pattern:
- Consultation: Often billable to insurance if it’s framed as an evaluation of joint pain or another medical complaint, but many cosmetic consultations are separate.
- PRP procedure: Almost always self‑pay, whether it’s for joints, hair, or under‑eye rejuvenation.
- Follow‑up: May be included in your procedure fee or billed separately, depending on the practice.
Bottom line for North Carolina Patients
For most people in Raleigh and across North Carolina, PRP is a self‑pay treatment, especially when used for joints, hair, or cosmetic rejuvenation. Medicare only covers PRP in very specific wound‑care scenarios, and private insurers generally follow similar logic.
That doesn’t make PRP less valuable, it just means it lives in a space where innovation has outpaced insurance policy. If you’re curious whether PRP makes sense for your goals, the next step is a conversation with us so we can explain both the medical side and the financial side clearly. To learn more or schedule a consultation, call us at (919) 929-6006 or visit our website. You can also reach out via our contact form.
