Quick Answer
Yes, Medicare Part B covers Durolane injections for knee osteoarthritis when medical necessity criteria are met. Durolane is a single-injection viscosupplement that uses NASHA (Non-Animal Stabilized Hyaluronic Acid) technology. Most patients pay 20% coinsurance after meeting their Part B deductible.
Medicare Part B Coverage for Durolane
Durolane is a stabilized hyaluronic acid injection manufactured by Bioventus. It uses a proprietary NASHA (Non-Animal Stabilized Hyaluronic Acid) process that creates a gel with high viscosity and prolonged residence time in the joint. Medicare covers Durolane under Part B (the medical benefit) because it is given in a physician’s office or outpatient setting.
Key coverage facts:
- Covered under Part B as a physician-administered injectable
- No prior authorization required under Original Medicare
- Subject to Local Coverage Determinations (LCDs) from your regional MAC
- Must meet medical necessity criteria documented in your medical records
- NASHA technology means non-animal stabilized HA (though the source is still avian)
Coverage Requirements
Medical Necessity Criteria
For Medicare to pay for Durolane, your medical records must show:
- Diagnosis of knee osteoarthritis with ICD-10 code M17.x
- Failure of conservative treatment for at least 3 months, including physical therapy, NSAIDs, or activity modification
- Chart documentation showing those treatments were not adequate
- X-ray evidence confirming osteoarthritis (most MACs require imaging within the past 12 months)
Billing Codes
| Code | Description | 2026 Estimated Allowable |
|---|---|---|
| J7318 | Durolane (hyaluronic acid), per dose | $600 - $800 |
| 20610 | Arthrocentesis, large joint (knee) | $85 - $110 |
| 77002 | Fluoroscopic guidance (if used) | $75 - $95 |
Your provider bills Medicare using J-code J7318 for Durolane. Since it is a single injection, the J-code is billed once per treatment course.
Frequency Limits
- Medicare typically covers one Durolane injection per knee every 6 months
- Some MACs allow repeat treatment after 6 months if the initial injection provided meaningful relief
- Bilateral knee treatment is generally covered when both knees have documented OA
- Your provider should document the clinical response to support repeat treatment
Your Out-of-Pocket Costs
| Item | Amount |
|---|---|
| Part B deductible (2026) | $257/year |
| Coinsurance | 20% of Medicare-approved amount |
| Typical total patient cost | $120 - $180 per injection |
| With Medigap | May cover the 20% coinsurance |
Example Cost Calculation
If Medicare approves $700 for a Durolane injection:
- Medicare pays: $560 (80%)
- You pay: $140 (20%)
- If you have a Medigap plan: your supplement may cover some or all of that $140
Medicare Advantage Plans
If you have a Medicare Advantage (Part C) plan:
- Coverage generally follows Original Medicare guidelines
- Prior authorization may be required — confirm with your plan before scheduling
- Copays vary by plan and may differ from the standard 20% coinsurance
- Network restrictions may apply — make sure your provider is in-network
- Contact your plan’s member services for coverage details before your visit
What If Medicare Denies Coverage?
If your Durolane claim is denied:
- Request the denial reason in writing
- Gather supporting documents including X-rays, treatment records, and your provider’s letter of medical necessity
- File a redetermination (Level 1 appeal) within 120 days
- Include clinical evidence showing why Durolane is medically necessary for your condition
Many initial denials are overturned on appeal when complete documentation is submitted.
Durolane Product Details
| Feature | Detail |
|---|---|
| Manufacturer | Bioventus |
| Active ingredient | Stabilized hyaluronic acid (NASHA) |
| Injection schedule | 1 injection per treatment course |
| FDA-approved for | Knee osteoarthritis |
| Technology | NASHA (Non-Animal Stabilized Hyaluronic Acid) |
| Source | Avian-derived, stabilized through proprietary process |
| Volume per injection | 3 mL |
Durolane’s NASHA technology stabilizes the hyaluronic acid through a minimal cross-linking process. This allows the product to resist degradation in the joint, potentially providing longer-lasting viscosity. The stabilization process preserves the natural properties of the hyaluronic acid while extending its residence time in the knee.
Frequently Asked Questions
How often will Medicare pay for Durolane?
Medicare generally covers one Durolane injection per knee every 6 months. Your provider must document medical necessity and clinical benefit from prior treatment to support repeat injections.
Do I need prior authorization for Durolane under Medicare?
No. Original Medicare does not require prior authorization for Durolane. If you have a Medicare Advantage plan, your plan may have prior authorization requirements. Verify with your plan before scheduling.
Is Durolane covered under Medicare Advantage?
Yes. Medicare Advantage plans must cover everything Original Medicare covers. Your plan may have different cost-sharing, network restrictions, or prior authorization rules. Contact your plan for specifics.
What does NASHA technology mean?
NASHA stands for Non-Animal Stabilized Hyaluronic Acid. It refers to the proprietary stabilization process used to manufacture Durolane. Despite the “non-animal stabilized” name, the hyaluronic acid itself is still derived from an avian (chicken comb) source. The stabilization process is what extends the gel’s duration in the joint.
How does Durolane compare to other single-injection HA products?
Durolane, Monovisc, Synvisc-One, and Gel-One are all single-injection viscosupplements. Each uses a different formulation technology. The choice between them is typically based on your provider’s clinical experience and preference. All are covered by Medicare. Discuss the options with your doctor.