Medicare Coverage for Joint Injections: Your Questions Answered

If you’re living with knee pain and considering injection therapy, you probably have questions about what Medicare covers. You’re not alone. Medicare coverage for joint injections can be confusing, with different rules for different types of treatments.

This guide answers the most common Medicare questions we hear from patients like you. Whether you’re considering gel shots (hyaluronic acid), cortisone injections, or newer treatments like PRP, we’ll help you understand what to expect.

Key Takeaways

• Medicare Part B covers hyaluronic acid (HA) injections and cortisone shots for knee osteoarthritis when medically necessary
• You’ll typically pay 20% of the Medicare-approved amount after meeting your deductible
• PRP and stem cell injections are generally not covered by Medicare
• Medicare Advantage plans may have different coverage rules
• Prior authorization is often required before treatment
• Understanding coverage requirements can help you avoid surprise bills

Does Medicare Cover Knee Injections?

Yes, Medicare Part B covers certain knee injections when they’re medically necessary. This includes:

Covered treatments:

• Hyaluronic acid injections (Synvisc, Euflexxa, Gel-One, Monovisc, etc.)
• Cortisone (corticosteroid) injections
• Diagnostic joint injections

Not covered:

• PRP (platelet-rich plasma) injections
• Stem cell treatments
• Experimental or investigational treatments

Medicare considers these injections “durable medical equipment” under Part B, the same part that covers doctor visits and outpatient care.

What Are Hyaluronic Acid Injections?

Hyaluronic acid (HA) injections, sometimes called “gel shots” or “viscosupplementation,” work by replacing the natural cushioning fluid in your knee joint. Think of it as adding oil to a squeaky hinge.

Medicare covers several FDA-approved HA brands, including:

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

The treatment typically involves one to five injections, depending on the brand. Medicare covers the full course of treatment when prescribed by your doctor.

What Does Medicare Require for Coverage?

Medicare has specific requirements before they’ll cover knee injections. Your doctor must document:

Medical necessity:

• Diagnosis of knee osteoarthritis (confirmed by X-ray or MRI)
• Failed conservative treatment for at least 6 weeks
• Documented functional limitations from knee pain

Conservative treatments include:

• Physical therapy
• Over-the-counter pain relievers (acetaminophen, ibuprofen)
• Weight loss attempts (if appropriate)
• Use of assistive devices (cane, walker, knee brace)

This doesn’t mean you must try every possible treatment. But Medicare wants proof that simpler treatments weren’t enough before approving injections.

How Much Will I Pay Out of Pocket?

If you have Original Medicare (Parts A and B), here’s what you’ll typically pay:

Your costs:

• Annual Part B deductible: $257 (2025)
• 20% coinsurance on the Medicare-approved amount
• No coverage limit once approved

Example cost breakdown: Let’s say the Medicare-approved amount for a Synvisc-One injection is $1,200.

• Medicare pays: $960 (80%)
• You pay: $240 (20%)
• Total out-of-pocket: $240 plus deductible if not yet met

If you have a Medicare Supplement (Medigap) plan, it may cover some or all of your 20% coinsurance.

Is Prior Authorization Required?

Many Medicare Advantage plans require prior authorization before knee injections. Original Medicare typically does not, but your doctor must still document medical necessity.

Prior authorization means:

• Your doctor submits treatment details to Medicare before the procedure
• Medicare reviews to confirm the treatment is medically necessary
• Approval usually takes 3-14 business days
• Treatment can proceed once approved

Tip: Ask your doctor’s office if prior authorization is required. They handle this process, but it’s good to know it’s happening so you’re not surprised by delays.

Does Medicare Cover Both Knees?

Yes, Medicare covers injections for both knees if both have osteoarthritis. Each knee is treated and billed separately.

However, some doctors prefer to treat one knee at a time, waiting 1-2 weeks between injections. This helps monitor how you respond to treatment and reduces the risk of complications.

What’s the Difference Between Medicare and Medicare Advantage?

Original Medicare (Parts A and B) follows standard federal coverage rules. Medicare Advantage (Part C) plans are run by private insurance companies and may have different rules.

Medicare Advantage differences:

• May require referrals to specialists
• Often requires prior authorization
• May limit which doctors you can see (network restrictions)
• Sometimes covers additional treatments (like acupuncture)
• May have different copays or coinsurance amounts

Important: If you have Medicare Advantage, call the number on your insurance card before scheduling treatment. Confirm coverage details and network requirements.

Does Medicare Cover Cortisone Injections?

Yes, Medicare Part B covers cortisone (corticosteroid) injections for knee pain when medically necessary. These are often used for:

• Acute inflammation
• Severe pain flares
• Quick relief before physical therapy
• When longer-lasting treatments aren’t appropriate

Cortisone injections typically cost less than HA injections. You’ll still pay 20% coinsurance after your deductible.

Medicare doesn’t limit how many cortisone injections you can receive, but doctors typically space them 3-4 months apart to minimize side effects.

Why Doesn’t Medicare Cover PRP or Stem Cells?

Medicare doesn’t cover PRP (platelet-rich plasma) or stem cell treatments because the FDA hasn’t approved them for knee osteoarthritis. Medicare only covers FDA-approved treatments with proven effectiveness.

If you’re considering PRP or stem cells:

• Expect to pay $500-$2,500 per treatment out of pocket
• Ask about payment plans
• Get cost estimates in writing before treatment
• Understand these are considered experimental by Medicare

Some patients choose to pay for these treatments themselves. That’s a personal decision, but it’s important to know Medicare won’t reimburse you.

How Do I Avoid Surprise Medical Bills?

Here are five ways to prevent unexpected costs:

1. Confirm coverage before treatment Call Medicare (1-800-MEDICARE) or your Medicare Advantage plan to verify coverage for the specific treatment your doctor recommends.

2. Use in-network providers If you have Medicare Advantage, confirm your doctor is in-network. Out-of-network care can cost significantly more.

3. Ask about facility fees Getting treatment in a hospital outpatient department costs more than a doctor’s office. Ask where the procedure will happen.

4. Get the Medicare-approved amount Ask your doctor’s billing office what Medicare pays for the procedure. This helps you calculate your 20% share.

5. Request an Advanced Beneficiary Notice (ABN) If your doctor thinks Medicare might deny coverage, they must give you an ABN explaining why and what you’ll owe if Medicare doesn’t pay.

What If Medicare Denies Coverage?

If Medicare denies coverage for your knee injections, you have the right to appeal. Here’s how:

Step 1: Understand why Read the denial letter carefully. Common reasons include:

• Missing documentation of failed conservative treatment
• No documented osteoarthritis diagnosis
• Treatment not considered medically necessary

Step 2: Talk to your doctor Your doctor may be able to provide additional documentation to support your case.

Step 3: File an appeal You have 120 days from the denial date to appeal. Your doctor’s office can help with this process.

Step 4: Request a redetermination This is the first level of appeal. A different Medicare reviewer will look at your case.

Success tip: Appeals work best when your doctor provides detailed notes explaining why you need the treatment and why simpler treatments haven’t worked.

Can I Get Injections More Than Once?

Yes, many patients receive multiple rounds of knee injections over time. Coverage depends on how well the treatment worked.

For HA injections:

• Many patients get relief for 6-12 months
• Medicare covers repeat treatment when pain returns
• No lifetime limit on treatments

For cortisone injections:

• Relief typically lasts 4-8 weeks
• Can be repeated as needed (with doctor guidance)
• Medicare covers multiple injections

Your doctor will track your response to treatment. If injections stop working, Medicare may question medical necessity for continued treatment.

How Often Will I Need Follow-Up Appointments?

Medicare covers follow-up appointments to monitor your progress. Typical schedule:

• 2-week follow-up after injection
• Monthly check-ins for the first 3 months
• Then as needed based on symptoms

These visits help your doctor document treatment effectiveness, which is important for future coverage approval.

Where Can I Learn More?

For detailed information about Medicare coverage for specific treatments:

• Medicare.gov: Official Medicare website with coverage search tool
• 1-800-MEDICARE: Speak with a representative about your specific situation
• Your doctor’s office: They can verify coverage for recommended treatments
• Medicare Advantage plan: Call the number on your insurance card

You can also visit our viscosupplementation coverage guide for more details about HA injection insurance.

Final Thoughts

Understanding Medicare coverage doesn’t have to be overwhelming. The key points to remember:

• Medicare covers HA and cortisone injections when medically necessary
• You’ll pay 20% after your deductible
• Prior authorization may be required
• Keep detailed records of conservative treatments you’ve tried
• Don’t hesitate to appeal if coverage is denied

If you’re considering knee injections, talk with your doctor about your specific situation. They can help you navigate Medicare requirements and ensure you get the coverage you’re entitled to.

---

This article is for informational purposes only and does not constitute medical or insurance advice. Medicare coverage can vary based on individual circumstances. Always consult with your healthcare provider and Medicare directly for personalized guidance.

Last medically reviewed: March 2025