Medical Review - Experimental/Investigational

Platelet Derived Wound Healing Formula, e.g. Gravitational Platelet Separation the GPS® System

Description
Platelet concentrate produced by the GPS® system is a platelet rich gel that is derived from the patient’s own blood. Platelet concentrate is then reintroduced to the wound to speed the body’s natural healing response.

This technology uses a centrifuge to separate out the patients own blood components by their various densities. The red blood cells (RBCs) are denser and will move to the bottom. The plasma fraction is the least dense and will float on the top layer. The “buffy coat” that contain the majority of platelets will be sandwiched below the plasma and above the RBCs.

The basic concept is by concentrating the platelets you also concentrate the growth factors, which will accelerate both the deposition of hard tissue as well as soft tissue repair.

Policy
Platelet derived wound healing formula, e.g. Gravitational Platelet Separation GPS® System is considered experimental/investigational due to the lack of sufficient published data to determine the safety and efficacy.

CPT Code
17999

Determined by the Medical Director on May 5, 2004.

(Web updated 2/2005)

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