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NCD 270.3 · version 6

NCD 270.3: Blood-Derived Products for Chronic Non-Healing Wounds

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: Medicare Coverage Database release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (every Thursday) for the MCD; quarterly for lab NCD code lists.

Key facts for NCD 270.3

Benefit category
Incident to a physician's professional Service
Effective date
04/13/2021
Implemented 11/09/2021
Transmittal
Transmittal 10981
Versions published
6
Manual chapter
270
NCD Manual (Pub. 100-03)

TL;DR

NCD 270.3 sets Medicare's national policy for blood-derived products for chronic non-healing wounds under the benefit category "Incident to a physician's professional Service", effective 04/13/2021 and implemented 11/09/2021. Effective for services performed on or after April 13, 2021, the Centers for Medicare & Medicaid Services (CMS) will cover autologous PRP for the treatment of chronic non-healing diabetic wounds under section 1862(a)(1)(A) of the Social Security Act (the… It has been revised 5 times since publication and binds every Medicare Administrative Contractor nationally.

Item or service described

A. General

Wound healing is a dynamic, interactive process that involves multiple cells and proteins. There are three progressive stages of normal wound healing, and the typical wound healing duration is about 4 weeks. While cutaneous wounds are a disruption of the normal, anatomic structure and function of the skin, subcutaneous wounds involve tissue below the skin's surface. Wounds are categorized as either acute, where the normal wound healing stages are not yet completed but it is presumed they will be, resulting in orderly and timely wound repair, or chronic, where a wound has failed to progress through the normal wound healing stages and repair itself within a sufficient time period.

Platelet-rich plasma (PRP) is produced in an autologous or homologous manner. Autologous PRP is comprised of blood from the patient who will ultimately receive the PRP. Alternatively, homologous PRP is derived from blood from multiple donors.

Blood is donated by the patient and centrifuged to produce an autologous gel for treatment of chronic, nonhealing cutaneous wounds that persist for 30 days or longer and fail to properly complete the healing process. Autologous blood derived products for chronic, non-healing wounds includes both: (1) platelet derived growth factor (PDGF) products, and (2) PRP (such as AutoloGel).

The PRP is different from previous products in that it contains whole cells including white cells, red cells, plasma, platelets, fibrin, stem cells, and fibrocyte precursors.

The PRP is used by physicians in clinical settings in treating chronic, non-healing wounds, open, cutaneous wounds, soft tissue and bone. Alternatively, PDGF does not contain cells and was previously marketed as a product to be used by patients at home.

Indications and limitations of coverage

B. Nationally Covered Indications

Effective for services performed on or after April 13, 2021, the Centers for Medicare & Medicaid Services (CMS) will cover autologous PRP for the treatment of chronic non-healing diabetic wounds under section 1862(a)(1)(A) of the Social Security Act (the Act) for a duration of 20 weeks, when prepared by devices whose Food and Drug Administration-cleared indications include the management of exuding cutaneous wounds, such as diabetic ulcers.

C. Nationally Non-Covered Indications

Autologous PDGF for the treatment of chronic, non-healing cutaneous wounds, and,

Becaplermin, a non-autologous growth factor for chronic, non-healing subcutaneous wounds, and,

Autologous PRP for the treatment of acute surgical wounds when the autologous PRP is applied directly to the closed incision, or for dehiscent wounds.

D. Other

Effective for services performed on or after April 13, 2021:

Coverage of autologous PRP for the treatment of chronic non-healing diabetic wounds beyond 20 weeks will be determined by the local Medicare Administrative Contractors (MACs).

Coverage of autologous PRP for the treatment of all other chronic non-healing wounds will be determined by the local MACs under section 1862(a)(1)(A) of the Act.

(This NCD last reviewed April 2021.)

Text reproduced from the CMS Medicare Coverage Database record for NCD 270.3 version 6. View the original on cms.gov.

Revision history

08/2026 - The purpose of this Change Request (CR) is to provide a quarterly maintenance update of ICD-10 coding conversions and other coding updates specific to National Coverage Determinations (NCDs). No policy is being changed as a result of these updates. ( TN 13906 ) (CR14537)

09/2025 - Transmittal 13383 issued August 26, 2025, is being rescinded and replaced by Transmittal 13401,

dated September 9, 2025, to add a new attachment to ensure the functionality of the NCD zip URL is working properly and to update the Policy section. All other information remains the same.

The purpose of this Change Request (CR) is to provide a quarterly maintenance update of ICD-10 coding conversions and other coding updates specific to National Coverage Determinations (NCDs). ( TN 13401 ) (CR14194)

10/2024 - The purpose of the Change Request (CR) is to provide a quarterly maintenance update of ICD-10 coding conversions and other coding updates specific to National Coverage Determinations(NCDs). No policy is being changed as a result of these updates. ( TN 12904 ) (CR13828)

06/2022 - Transmittal 11400, dated May 4, 2022, is being rescinded and replaced by Transmittal 11460, dated, June 17, 2022, to update NCD 90.2, NGS, spreadsheet to conform with changes in CR 12124, and change the implementation date for all business requirements except 12705.6 to 30 days from issuance of this correction. All other information remains the same.( TN 11460 ) (CR12705)

05/2022 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. ( TN 11400 ) (CR12705)

04/2022 - Transmittal 11262, dated February 10, 2022, is being rescinded and replaced by Transmittal 11364, dated, April 27, 2022, to include new business requirement 2611.6 for new CWF requirements to FISS. All other information remains the same.( TN 11364 ) (CR12611)

02/2022 - Transmittal 11262, dated February 10, 2022, is to inform contractors of the CWF frequency editing for the NCD 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds. ( TN 11262 ) (CR12611)

01/2022 - Transmittal 11171, dated January 12, 2022, is being rescinded and replaced by Transmittal 11214, dated, January 20, 2022 to provide clarification to the note in the Claims Processing business instructions, Pub.100-04, business requirement 12403.04-01 and to update the title for the NCD 270.3 Blood Derived Products for Chronic Non-healing Wounds attachment. This correction does not make any revisions to the companion publication 100-03; all revisions are associated with publication 100-04. All other information remains the same. ( TN 11214 ) (CR12403)

01/2022 - Transmittal 11119, dated September 10, 2021, is being rescinded and replaced by Transmittal 11171, dated, January 12, 2022 to add HCPCS code G0465 to the instructions and to include additional information on HCPCS code G0460. This correction modifies the IOM attachment for publication 100-04, it also updates the background section for publication 100-04, and business requirements 12403 - 04.1 through 12403 - 04.2.2 and 12403 - 04.3 through 12403 - 04.6. This correction does not make any revisions to the companion publication 100-03; all revisions are associated with publication 100-04. All other information remains the same. ( TN 11171 ) (CR12403)

11/2021 - Transmittal 10981, dated September 8, 2021, is being rescinded and replaced by Transmittal 11119, dated, November 10, 2021 to: (1) change Business Requirements (BRs) 12403 - 04.2, BR 12403 - 04.2.1 and BR 12403 - 04.2.2 to deny, (2) revise BR 12403 - 04.4.2.2 messaging, (3) add BR 12403 - 04.2.2.1 (4) remove Part A from BR 12403 - 04.3 and BR 12403 - 04.3.1, (5) revise verbiage in BR 12403 - 04.5, and extends the implementation date. This correction does not make any revisions to the companion publication 100-03; all revisions are associated with publication 100-04. All other information remains the same. ( TN 11119 ) (CR12403)

09/2021 - The purpose of this change request is to inform MACs that effective April 13, 2021, CMS will cover autologous Platelet-Rich Plasma (PRP) for the treatment of chronic non-healing diabetic wounds under specific conditions. ( TN 10981 ) (CR12403)

11/2018 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html , along with other CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.( TN 2200 ) (CR10859)

09/2018 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html , along with other CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.( TN 2138 ) (CR10859)

08/2018 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding to feedback received.

Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html , along with other CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process. ( TN 2122 ) (CR10859)

01/2018 - This Change Request (CR) constitutes a maintenance update of International Code of Diseases, Tenth Revision (ICD-10)

How this NCD shows up on remittances

A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.

How QuickIntell applies NCD 270.3

QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.

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Frequently asked questions — NCD 270.3

What does NCD 270.3 cover?

Effective for services performed on or after April 13, 2021, the Centers for Medicare & Medicaid Services (CMS) will cover autologous PRP for the treatment of chronic non-healing diabetic wounds under section 1862(a)(1)(A) of the Social Security Act (the Act) for a duration of 20 weeks, when prepared by devices whose Food and Drug Administration-cleared indications include the management of exuding cutaneous… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.

When did NCD 270.3 take effect?

The current version (6) is effective 04/13/2021, implemented 11/09/2021, published in transmittal 10981. CMS lists 6 versions of this NCD.

Does a Local Coverage Determination override NCD 270.3?

No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.