Cigna Viscosupplementation Coverage
Yes, Cigna covers viscosupplementation for knee osteoarthritis when prior authorization criteria are met. You must have tried and failed conservative treatments before Cigna will approve the procedure.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Covered? | Yes (knee OA) |
| Prior Authorization | Required |
| Conservative TX First | Yes (3+ months) |
| Your Cost | Plan-specific coinsurance |
What Cigna Requires
Cigna’s medical coverage policy requires:
- Confirmed knee osteoarthritis with imaging evidence
- At least 3 months of conservative treatment that did not provide adequate relief:
- Physical therapy or exercise
- Oral pain medications (NSAIDs, acetaminophen)
- Activity modification or weight loss
- Prior authorization submitted by your treating physician
- In-network provider performing the injection
Covered Benefit
Cigna covers viscosupplementation for knee OA. Have your doctor document all previous treatments and submit prior authorization with complete records.
Covered Products
| Brand | Injection Schedule | Notes |
|---|---|---|
| Synvisc-One | Single injection | Most common |
| Euflexxa | 3 weekly injections | Popular choice |
| Hyalgan | 3-5 weekly injections | Established brand |
| Orthovisc | 3-4 weekly injections | Mid-range option |
| Gel-One | Single injection | Single-injection option |
Cigna may have preferred brands that result in lower out-of-pocket costs. Ask your provider about Cigna’s preferences.
What You Will Pay
| Plan Type | Typical Cost |
|---|---|
| PPO in-network | 20% coinsurance after deductible |
| HMO | Specialist copay applies |
| High-deductible | Full cost until deductible met |
| Out-of-network | 40-60% coinsurance |
Total cost before insurance is typically $800-$2,000 per treatment series, depending on the product used.
Step-by-Step Authorization Process
- Visit your orthopedist for evaluation and imaging
- Complete conservative treatment for at least 3 months
- Your doctor submits prior auth to Cigna with medical records
- Cigna reviews the request (usually 5-15 business days)
- If approved, schedule the injection with an in-network provider
- If denied, your doctor can request peer-to-peer review
Plan Ahead
Prior authorization can take up to 15 business days. Start the process well before you need the injection to avoid delays.
Frequently Asked Questions
How often will Cigna cover viscosupplementation?
Cigna typically covers one treatment course per knee every 6 months. Repeat treatments must also receive prior authorization.
Does Cigna cover this for hip or shoulder arthritis?
Cigna’s coverage for viscosupplementation is generally limited to knee osteoarthritis. Off-label use for other joints is typically denied.
What if I already tried cortisone and it did not help?
Failed cortisone injections strengthen your case for viscosupplementation approval. Make sure your doctor includes this in the prior authorization request.