Does Medicare Cover Gel Injections? Complete 2026 Guide

If you have knee osteoarthritis and are considering gel injections, you probably have one burning question: Will Medicare pay for this?

The short answer is yes. Medicare Part B covers gel injections (also called viscosupplementation or hyaluronic acid injections) when they meet specific medical necessity requirements. But understanding exactly what Medicare covers, what you’ll pay, and how to qualify can save you from unexpected bills and coverage denials.

This guide walks you through everything you need to know about Medicare coverage for gel injections in 2026.

Key Takeaways

• Yes, Medicare Part B covers gel injections when medically necessary for knee osteoarthritis
• 2026 Part B deductible: $257 (you pay this once per year before Medicare kicks in)
• After deductible: Medicare pays 80%, you pay 20%
• Estimated out-of-pocket cost: Around $320 for a typical injection series
• Medicare spent over $440 million on hyaluronic acid injections in 2019 alone
• Coverage requires: Documented OA, failed conservative treatments, and often a trial of cortisone injections
• Repeat courses are allowed if symptoms return and at least 6 months have passed

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The Short Answer: Yes, Medicare Covers Gel Injections

Medicare Part B considers gel injections a covered outpatient service when they’re medically necessary. This means your doctor must document that:

1. You have knee osteoarthritis confirmed by imaging (X-ray or MRI)
2. You’ve tried and failed other treatments first
3. The injection is appropriate for your condition

Medicare doesn’t consider gel injections experimental. They’ve been FDA-approved since 1997 and are covered under the same Part B guidelines as other outpatient procedures like cortisone injections or physical therapy.

The coverage applies to several FDA-approved hyaluronic acid brands, including:

• Synvisc and Synvisc-One
• Euflexxa
• Gel-One
• Monovisc
• Orthovisc
• Supartz FX
• Hyalgan

Each brand has a slightly different injection schedule (ranging from a single injection to a series of 3-5 weekly injections), but Medicare covers the full prescribed course for all FDA-approved products.

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What Medicare Part B Covers

Medicare Part B (the part that covers outpatient services and doctor visits) pays for gel injections as a medical procedure. Here’s what falls under Part B coverage:

Covered:

• The gel injection medication itself
• The injection procedure performed by your doctor
• Fluoroscopic or ultrasound guidance if used to ensure accuracy
• Office visit associated with the injection
• Follow-up appointments to monitor your response

Not covered under Part B:

• Prescription oral medications (covered under Part D)
• Over-the-counter supplements like glucosamine
• Experimental treatments like PRP or stem cell injections

Medicare processes gel injection claims as durable medical equipment (DME) under specific billing codes. Your doctor’s office handles all this billing—you don’t need to worry about the technical details.

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Your Out-of-Pocket Costs in 2026

Let’s break down exactly what you’ll pay with Original Medicare (Parts A and B):

The Medicare Cost Formula

Component	2026 Amount
Part B annual deductible	$257
Your coinsurance	20% of Medicare-approved amount
Medicare pays	80% of Medicare-approved amount

Example Cost Breakdown

Let’s say you get a Synvisc-One injection (a single-injection treatment). If the Medicare-approved amount is $1,600:

Who Pays	Amount
Medicare pays (80%)	$1,280
You pay (20%)	$320
Your total out-of-pocket	$320 + deductible if not yet met

For a typical gel injection series, expect to pay around $200-$400 out of pocket after Medicare’s portion, depending on which product your doctor uses and whether you’ve met your deductible.

Ways to Reduce Your Costs

If you have a Medigap (Medicare Supplement) plan:

• Medigap Plan F or G covers your 20% coinsurance
• This could reduce your out-of-pocket to just the Part B deductible
• Some plans may cover the deductible too

If you qualify for Medicare Savings Programs:

• Programs like QMB, SLMB, or QI help pay premiums and cost-sharing
• Contact your state Medicaid office to check eligibility

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Requirements for Medicare Coverage

Medicare won’t automatically cover gel injections just because you have knee pain. Your doctor must document that you meet specific medical necessity criteria.

Required Documentation

1. Confirmed Knee Osteoarthritis

You need imaging evidence (X-ray or MRI) showing osteoarthritis in your knee. A clinical diagnosis alone isn’t sufficient—Medicare requires objective proof.

2. Failed Conservative Treatments

You must have tried and failed at least three conservative treatments from this list:

• Pain or anti-inflammatory medications (NSAIDs like ibuprofen, acetaminophen, or prescription options)
• Physical therapy (documented sessions with a licensed therapist)
• Exercise programs (structured activity to strengthen the joint)
• Weight management (if applicable to your situation)
• Assistive devices (knee brace, cane, or walker)

3. Cortisone Injection Trial or Contraindication

This is the requirement that trips up many patients. Medicare typically requires that you either:

• Tried glucocorticoid (cortisone) injections without adequate relief, OR
• Have a documented contraindication to cortisone (such as uncontrolled diabetes, active infection, or history of adverse reaction)

Your doctor must document this clearly in your medical record. If you skip this step, Medicare may deny your claim.

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How to Qualify: Step-by-Step

Follow this path to ensure your gel injections get covered:

Step 1: Get Proper Diagnosis

Schedule an appointment with your doctor to evaluate your knee pain. Request imaging (X-ray is typically sufficient) to confirm osteoarthritis and document its severity.

Step 2: Try Conservative Treatments First

Work with your doctor to document that you’ve tried:

• Over-the-counter or prescription pain medications
• Physical therapy (keep records of your sessions)
• Exercise or activity modifications
• A knee brace if recommended
• Weight management if applicable

Keep your own records too. Note dates, what you tried, and how long you tried it.

Step 3: Consider Cortisone Injection

If conservative treatments haven’t provided adequate relief, discuss a cortisone injection with your doctor. This step:

• May provide relief on its own
• Satisfies Medicare’s requirement if it doesn’t work well enough
• Creates documentation for your gel injection authorization

Step 4: Request Gel Injections

Once you’ve met the requirements, ask your doctor about gel injections. They’ll need to:

• Document your treatment history
• Note why gel injections are appropriate
• Submit for prior authorization if required by your Medicare Advantage plan

Step 5: Verify Coverage Before Treatment

For Original Medicare: Your doctor’s billing department should verify coverage. Ask them to confirm the procedure is covered before your appointment.

For Medicare Advantage: Call your plan directly. Ask about:

• Prior authorization requirements
• Network restrictions (must you use specific providers?)
• Any copay or cost-sharing differences from Original Medicare

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What Medicare Allows for Treatment

Understanding Medicare’s treatment guidelines helps you know what to expect:

Treatment Course Limits

• One course of therapy per knee per approval period
• A course equals 3-5 injections depending on the product (or one injection for single-dose products like Synvisc-One or Monovisc)
• Both knees can be treated if both have documented osteoarthritis

Repeat Courses Are Allowed

Good news: if gel injections help but the effects wear off, you can get another round. Medicare allows repeat courses when:

• Symptoms persist or return after the initial course
• The first course provided improvement (documented in your records)
• At least 6 months have passed since your last injection series

There’s no lifetime limit on how many courses you can receive, as long as you continue to meet medical necessity criteria and the injections continue to provide benefit.

Timing Considerations

• Most patients experience relief for 6-12 months per injection series
• Some patients get relief for longer; others may need repeat treatment sooner
• Your doctor will monitor your response and recommend timing for repeat treatment

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Medicare Advantage: What’s Different

If you have Medicare Advantage (Part C) instead of Original Medicare, your coverage works a bit differently:

Key Differences

Factor	Original Medicare	Medicare Advantage
Prior authorization	Usually not required	Often required
Network restrictions	See any provider who accepts Medicare	May require in-network providers
Cost-sharing	Standard 20% coinsurance	Varies by plan—could be more or less
Covered products	All FDA-approved brands	May prefer certain brands

What to Do Before Treatment

1. Call your plan using the number on your insurance card
2. Ask specifically about viscosupplementation or gel injections for knee osteoarthritis
3. Confirm if prior authorization is needed (most MA plans require it)
4. Verify your doctor is in-network
5. Get cost estimates for your specific plan

Prior Authorization Process

If your Medicare Advantage plan requires prior authorization:

• Your doctor’s office submits the request
• Include all documentation of failed conservative treatments
• Typical processing time is 3-14 business days
• Don’t schedule your injection until authorization is confirmed

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What If Medicare Denies Coverage?

Denials happen, but they’re not the final word. You have the right to appeal.

Common Denial Reasons

• Missing documentation of failed conservative treatment
• No imaging evidence of osteoarthritis
• Cortisone step not documented (no trial or contraindication noted)
• Treatment coded incorrectly by the billing department
• Prior authorization not obtained (for Medicare Advantage)

How to Appeal

Step 1: Understand the denial

Read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) carefully. It explains exactly why the claim was denied.

Step 2: Talk to your doctor

Your doctor may be able to provide additional documentation. Sometimes a denial results from incomplete records, not an actual coverage issue.

Step 3: Request a redetermination

This is the first level of appeal. You have 120 days from the denial date to file. Your doctor’s office can help with this process.

Step 4: Continue appealing if needed

Medicare has multiple appeal levels:

1. Redetermination (by the Medicare contractor)
2. Reconsideration (by a Qualified Independent Contractor)
3. Administrative Law Judge hearing
4. Medicare Appeals Council review
5. Federal court review

Most successful appeals are resolved at levels 1 or 2.

Tips for Successful Appeals

• Provide detailed documentation of your treatment history
• Include your doctor’s notes explaining why gel injections are medically necessary
• Show the progression from conservative treatments to cortisone to gel injections
• Don’t give up after one denial—appeals often succeed

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Tips for Ensuring Coverage

Maximize your chances of smooth coverage with these practical steps:

Before Your Appointment

• Get imaging done (X-ray or MRI showing knee OA)
• Gather records of all conservative treatments you’ve tried
• Document physical therapy dates and outcomes
• Note medication history (what you’ve tried, how long, results)
• Prepare to discuss cortisone injection history or contraindications

At Your Appointment

• Ask about prior authorization and who handles it
• Confirm coverage verification before scheduling the procedure
• Understand your costs (deductible status, coinsurance amount)
• Get copies of all documentation for your records

After Your Injection

• Keep your receipts and Explanation of Benefits statements
• Track your response to treatment (for future documentation)
• Note the date for planning any repeat treatment
• Follow up on any billing issues promptly

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Frequently Asked Questions

Does Medicare cover gel injections for both knees?

Yes. If both knees have documented osteoarthritis and meet medical necessity criteria, Medicare covers treatment for both. Your doctor may treat both knees on the same day or schedule them separately.

How long do I have to wait between injection series?

Medicare requires at least 6 months between courses of gel injections for the same knee. This timing is based on how long the effects typically last and ensures appropriate use.

Will Medicare cover gel injections for my hip or shoulder?

Currently, Medicare coverage for hyaluronic acid injections focuses on knee osteoarthritis. Coverage for other joints is more limited and varies by contractor. Ask your doctor about coverage for non-knee joints.

What if I haven’t met my Part B deductible?

You’ll pay the deductible first ($257 in 2026), then 20% coinsurance after that. If you’ve already met your deductible for the year, you only pay the 20% coinsurance.

Can I choose which gel injection brand I receive?

Your doctor typically recommends the brand based on your situation and what works well in their practice. However, you can discuss options and preferences. All FDA-approved brands are covered by Medicare.

Does Medicare Advantage cover the same brands as Original Medicare?

Medicare Advantage must cover gel injections but may have preferred brands or require certain products. Check with your specific plan about which brands are covered and at what cost.

How do I know if my doctor accepts Medicare?

Most doctors who treat osteoarthritis accept Medicare. Ask when scheduling your appointment, or search Medicare’s Physician Compare tool at Medicare.gov.

What’s the difference between gel injections and cortisone injections for Medicare coverage?

Both are covered by Medicare Part B. Cortisone injections are typically tried first because they’re less expensive and work quickly. Gel injections are covered when cortisone hasn’t provided adequate relief.

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Patient Checklist: Getting Medicare Coverage for Gel Injections

Print this checklist to take to your doctor’s appointment:

Documentation Needed

• X-ray or MRI showing knee osteoarthritis
• Records of conservative treatments tried (minimum 3)
• Physical therapy documentation (dates, number of sessions)
• List of pain medications tried with dates and duration
• Cortisone injection history (dates, response) OR documented contraindication

Questions to Ask Your Doctor

• Do I meet Medicare’s requirements for gel injections?
• Which product do you recommend and why?
• Will you handle prior authorization if needed?
• What will my out-of-pocket cost be?
• When can I schedule the procedure?

Questions for Your Insurance

• Is prior authorization required?
• Do I need to use a specific provider or facility?
• What’s my expected copay or coinsurance?
• Are there any brand restrictions?

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Final Thoughts

Medicare coverage for gel injections gives millions of Americans with knee osteoarthritis access to an effective, low-risk treatment option. The key to smooth coverage is understanding the requirements and making sure your medical records tell the complete story of your treatment journey.

Remember:

• Yes, Medicare Part B covers gel injections when medically necessary
• Document everything—your treatment history matters
• Follow the stepped approach (conservative treatments, then cortisone, then gel injections)
• Ask questions before treatment to avoid surprises
• Appeal if denied—many denials are overturned

If you’ve been living with knee pain and wondering whether gel injections might help, talk to your doctor about whether you’re a candidate. With proper documentation and the right preparation, Medicare can help cover this treatment option.

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This article is for informational purposes only and does not constitute medical or insurance advice. Medicare coverage can vary based on individual circumstances and plan type. Always consult with your healthcare provider and contact Medicare directly (1-800-MEDICARE) or your Medicare Advantage plan for personalized guidance.

Last medically reviewed: January 2026

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Related Resources

Insurance Cluster

• Why 30% of Insurance Plans Don’t Cover Gel Injections
• Prior Authorization for Gel Injections: What You Need to Know
• Gel Injections vs Knee Replacement: Cost Comparison

Understanding the Treatment

• The FDA-Approved Treatment 80% of Patients Have Never Heard Of
• FDA-Approved Since 1997: The 27-Year History of Gel Injections
• How Long Do Gel Injections Last?

Why You May Not Have Heard About This

• Why Your Doctor May Not Have Mentioned Gel Injections
• AAOS vs OARSI: Why Medical Guidelines Disagree

Hub Pages

• What Is Viscosupplementation?
• Hyaluronic Acid Injections: Treatment Guide
• Medicare Coverage Guide