Humana Viscosupplementation Coverage
Yes, Humana covers viscosupplementation for knee osteoarthritis on both commercial and most Medicare Advantage plans. Prior authorization is required, and you must have tried conservative treatments first.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Commercial Plans | Yes (with PA) |
| Medicare Advantage | Yes (follows Medicare) |
| Prior Authorization | Required |
| Conservative TX First | Yes |
Coverage by Plan Type
Humana Commercial Plans
Coverage requires prior authorization and documented failure of conservative treatments. Your cost share depends on your plan’s coinsurance and deductible structure.
Humana Medicare Advantage
Humana MA plans follow Medicare’s coverage guidelines for viscosupplementation. Medicare considers viscosupplementation medically necessary for knee OA, so Humana MA plans cover it with appropriate documentation.
Good News for Humana MA Members
If you have Humana Medicare Advantage, viscosupplementation follows Medicare’s established coverage guidelines, which have covered this treatment since 1997.
Requirements for Approval
- Knee osteoarthritis diagnosis confirmed by X-ray or MRI
- Conservative treatment history documenting:
- Physical therapy or home exercise program
- Pain medications (NSAIDs, acetaminophen)
- Activity modification
- Prior authorization submitted by your provider
- In-network provider performing the procedure
Covered Brands
| Brand | Injection Schedule | Type |
|---|---|---|
| Synvisc-One | Single injection | High molecular weight |
| Euflexxa | 3 weekly | Bio-fermented |
| Hyalgan | 3-5 weekly | Low molecular weight |
| Orthovisc | 3-4 weekly | High molecular weight |
| Monovisc | Single injection | High concentration |
What You Will Pay
| Plan Type | Typical Cost |
|---|---|
| Commercial PPO | 20% coinsurance after deductible |
| Commercial HMO | Specialist copay + coinsurance |
| Medicare Advantage | 20% coinsurance (or plan copay) |
| High-deductible | Full cost until deductible met |
Check Your Deductible
If you have not met your annual deductible, you may owe the full cost of the injection upfront. Call Humana to understand your current deductible status before scheduling.
Frequently Asked Questions
How often can I get viscosupplementation with Humana?
Most plans approve one series per knee every 6 months. Each series requires a new prior authorization.
Does Humana cover viscosupplementation for both knees?
Yes. Each knee is treated separately, and each requires its own prior authorization.
What if my Humana plan denies coverage?
Ask your doctor to request a peer-to-peer review. If denied again, file a formal appeal with additional medical documentation. Humana MA members can also contact 1-800-MEDICARE.