Aetna Coverage for HA Injections
Aetna covers hyaluronic acid injections for knee osteoarthritis on most plans, but prior authorization is typically required. Coverage varies by plan type.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Covered? | Yes (most plans) |
| Prior Authorization | Required |
| Network | In-network recommended |
| Your Cost | Varies by plan |
Prior Authorization Required
Aetna requires prior authorization for viscosupplementation:
Getting Approved
- Provider submits authorization request
- Required documentation:
- OA diagnosis (ICD-10 M17.x)
- X-ray evidence of joint changes
- Record of failed conservative treatment
- Medical necessity statement
- Wait for approval (5-15 business days)
- Treatment after approval received
Coverage Requirements
Conservative Treatment First
Aetna typically requires documentation of:
- Physical therapy: 4-6 weeks minimum
- Medications: NSAIDs, acetaminophen
- Activity modification: Weight management, low-impact exercise
Medical Necessity
- Documented moderate-to-severe knee OA
- Functional impairment affecting daily activities
- Appropriate candidate for injection therapy
What You’ll Pay
| Plan Type | Typical Cost |
|---|---|
| PPO in-network | $50-$150 copay |
| HMO | $40-$100 copay |
| High-deductible | Full cost until deductible |
| Out-of-network | Higher coinsurance |
Tips for Approval
- Complete conservative treatment before requesting
- Ensure documentation is thorough
- Use in-network provider
- Follow up on authorization status
- Request peer-to-peer if initially denied