Does Medicare Cover Arthrosamid? (2026 Status)

Quick Answer

No, Medicare does not cover Arthrosamid. As of 2026, Arthrosamid is not FDA-approved in the United States and has no HCPCS billing code. There is no coverage pathway through Medicare Part A, Part B, Part D, or Medicare Advantage for this treatment. All costs must be paid entirely out of pocket.

Why Medicare Cannot Cover Arthrosamid

Medicare coverage for injectable treatments requires a clear chain of regulatory approvals. Arthrosamid has not met any of the necessary steps:

Step 1: FDA Approval (Not Met)

The Food and Drug Administration must approve a medical product before Medicare can consider covering it. Arthrosamid is CE-marked in Europe but has not completed the US FDA approval process. Contura International is pursuing approval, but no timeline has been confirmed.

Step 2: HCPCS Code Assignment (Not Met)

Every injectable covered by Medicare Part B has a specific HCPCS (Healthcare Common Procedure Coding System) code used for billing. For example, Synvisc-One uses J7325 and Euflexxa uses J7323. Arthrosamid has no HCPCS code because it is not an approved product.

Step 3: Coverage Determination (Not Met)

After FDA approval and code assignment, the Centers for Medicare and Medicaid Services (CMS) or regional Medicare Administrative Contractors (MACs) must issue a coverage determination. No national coverage determination (NCD) or local coverage determination (LCD) exists for polyacrylamide hydrogel knee injections.

Until all three steps are completed, Medicare coverage is not possible. This is not a denial that can be appealed. The product simply does not exist in the Medicare reimbursement system.

When Might Medicare Cover Arthrosamid?

This depends entirely on the FDA approval timeline:

These are rough estimates. The actual timeline could be shorter or longer depending on how quickly the FDA review proceeds and whether CMS issues coverage proactively or waits for requests.

What About Medicare Advantage Plans?

Medicare Advantage (Part C) plans generally follow the same coverage rules as Original Medicare for injectable treatments. Since Arthrosamid is not FDA-approved:

• No Medicare Advantage plan covers Arthrosamid
• Supplemental benefits offered by some MA plans do not extend to non-approved products
• This applies to all MA plans regardless of insurer (UnitedHealthcare, Humana, Aetna, etc.)

What About Paying Out of Pocket With Medicare?

Some patients ask whether they can pay for Arthrosamid themselves while keeping their Medicare coverage for other services. Here is the situation:

• You cannot receive Arthrosamid at US clinics because it is not available in the US (except through clinical trials)
• If you travel abroad for the treatment, Medicare does not cover medical care received outside the United States (with very limited exceptions)
• Your Medicare coverage for other treatments is not affected by receiving Arthrosamid abroad on your own

If you travel to Europe or the UK for Arthrosamid, expect to pay the full cost of $3,000 to $5,000 plus travel expenses. Your US Medicare benefits remain intact for all other covered services.

Medicare-Covered Alternatives That Work Today

While Arthrosamid is not an option through Medicare, several effective knee injection treatments are covered:

Hyaluronic Acid Injections (Covered)

Medicare Part B covers HA injections for knee osteoarthritis when medical necessity criteria are met.

Requirements for HA coverage:

• Documented knee osteoarthritis diagnosis
• Failed conservative treatment (PT, medications)
• Treatment by a Medicare-enrolled provider
• No prior authorization needed under Original Medicare

Cortisone Injections (Covered)

• Rapid relief for flare-ups
• Medicare Part B covered with low out-of-pocket cost
• Limitations: Repeated use may damage cartilage; typically limited to 3-4 per year per joint

Physical Therapy (Covered)

• Medicare Part B covers PT for knee osteoarthritis
• No annual cap on medically necessary therapy
• Evidence-based for improving function and reducing pain
• 20% coinsurance applies after Part B deductible

Comparison: Arthrosamid vs. Medicare-Covered Options

Frequently Asked Questions

Can I appeal a Medicare denial for Arthrosamid?

No. Medicare has not denied Arthrosamid coverage. The product simply does not exist in the Medicare coverage system because it is not FDA-approved. There is nothing to appeal. Once the product gains FDA approval and receives a billing code, coverage determinations will follow.

Will Medicare ever cover Arthrosamid?

It is possible, but only after FDA approval. If Arthrosamid receives FDA approval and CMS issues a favorable coverage determination, Medicare Part B would likely cover it under similar rules as HA injections. This is speculative and depends on the regulatory pathway.

Can my doctor bill Medicare for Arthrosamid using a miscellaneous code?

No. Billing Medicare for a non-approved product using a miscellaneous HCPCS code (like J3490) would be improper. Medicare cannot reimburse for products that have not been cleared by the FDA. Any such claim would be denied and could result in compliance issues for the provider.

What if I am in a clinical trial for Arthrosamid?

Medicare has a coverage pathway for clinical trials (Clinical Trial Policy). If you are enrolled in a qualifying Arthrosamid clinical trial, Medicare may cover the routine costs of your care (office visits, imaging) but not the investigational product itself. The trial sponsor covers the cost of Arthrosamid.

Are there any knee injections that last longer than HA and are Medicare-covered?

Currently, no. HA injections lasting 6-12 months are the longest-duration injectable treatment covered by Medicare for knee OA. Cortisone lasts weeks. If Arthrosamid gains approval, it would be the first multi-year option, but that has not happened yet.

I saw a clinic offering Arthrosamid in the US. Is that legitimate?

Be very cautious. Arthrosamid is not legally available for commercial use in the United States. If a clinic claims to offer it outside of an FDA-registered clinical trial, this raises serious concerns about the legitimacy of the product and the clinic.

What to Do Next

1. Talk to your doctor about Medicare-covered knee injection options available today
2. Consider HA injections if you have not tried them. They are proven, covered, and effective
3. Maximize physical therapy as a foundation for managing knee OA
4. Stay informed about Arthrosamid’s FDA progress for future consideration

Related Resources

• Arthrosamid Knee Injection: What to Know (2026 Guide)
• Medicare Coverage for HA Injections
• Arthrosamid vs. Hyaluronic Acid
• Hyaluronic Acid Injections: Complete Guide
• Medicare Part B Coverage Guide