Recombinant platelet-derived growth factor (ie, becaplermin) may be considered medically necessary when used as an adjunct to standard wound management for the following indications (for further information on patient selection criteria, see Policy Guidelines next):
Neuropathic diabetic ulcers extending into the subcutaneous tissue
Pressure ulcers extending into the subcutaneous tissue.
Other applications of recombinant platelet-derived growth factor (ie, becaplermin) are considered investigational, including, but not limited to, ischemic ulcers, venous stasis ulcers, and ulcers not extending through the dermis into the subcutaneous tissue.
Use of platelet-rich plasma (ie, autologous blood-derived preparations) is considered investigational for the treatment of acute or chronic wounds, including surgical wounds and nonhealing ulcers.