Quick Answer
Yes, Medicare Part B covers Euflexxa injections for knee osteoarthritis when medical necessity criteria are met. Euflexxa is the only biofermented (non-avian) hyaluronic acid option, making it a preferred choice for patients with poultry allergies. Most patients pay 20% coinsurance after meeting their Part B deductible.
Medicare Part B Coverage for Euflexxa
Euflexxa is a sodium hyaluronate injection made by Ferring Pharmaceuticals using a bacterial fermentation process rather than an animal-derived source. Medicare covers Euflexxa under Part B (the medical benefit), not Part D (the pharmacy benefit), because it is administered in a physician’s office.
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
- Unique advantage: non-avian source means patients with poultry allergies can safely receive it
Coverage Requirements
Medical Necessity Criteria
For Medicare to pay for Euflexxa, 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 these treatments did not provide adequate relief
- X-ray evidence confirming osteoarthritis (most MACs require imaging within the past 12 months)
Billing Codes
| Code | Description | 2026 Estimated Allowable |
|---|---|---|
| J7323 | Euflexxa (sodium hyaluronate), per dose | $250 - $350 per injection |
| 20610 | Arthrocentesis, large joint (knee) | $85 - $110 |
| 77002 | Fluoroscopic guidance (if used) | $75 - $95 |
Your provider bills Medicare using J-code J7323 for each Euflexxa injection. Since it is a 3-injection series, this code is submitted three times over the treatment course.
Frequency Limits
- Medicare typically covers one treatment course (3 weekly injections) per knee every 6 months
- Some MACs allow repeat treatment after 6 months if the initial course provided meaningful relief
- Bilateral knee treatment is generally covered when both knees have documented OA
- Your provider should document 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 | $150 - $250 per 3-injection series |
| With Medigap | May cover the 20% coinsurance |
Example Cost Calculation
If Medicare approves $300 per injection ($900 total for 3 injections):
- Medicare pays: $720 (80%)
- You pay: $180 (20%)
- If you have a Medigap plan: your supplement may cover some or all of that $180
Medicare Advantage Plans
If you have a Medicare Advantage (Part C) plan:
- Coverage generally follows Original Medicare guidelines
- Prior authorization may be required — check with your plan before scheduling
- Copays vary by plan and may differ from the standard 20% coinsurance
- Network restrictions may apply — confirm your provider is in-network
- Contact your plan’s member services to verify coverage before your appointment
What If Medicare Denies Coverage?
If your Euflexxa claim is denied:
- Request the denial reason in writing
- Gather supporting documents including X-rays, treatment history, and provider letter of medical necessity
- File a redetermination (Level 1 appeal) within 120 days
- Emphasize medical necessity — if you chose Euflexxa due to a poultry allergy, include documentation of the allergy
Many initial denials are overturned on appeal when proper documentation is submitted.
Euflexxa Product Details
| Feature | Detail |
|---|---|
| Manufacturer | Ferring Pharmaceuticals |
| Active ingredient | Sodium hyaluronate (1% solution) |
| Injection schedule | 3 injections, given 1 week apart |
| FDA-approved for | Knee osteoarthritis |
| Molecular weight | 2.4 - 3.6 million daltons |
| Source | Biofermented (non-avian, bacterial fermentation) |
| Volume per injection | 2 mL |
Euflexxa is the only FDA-approved viscosupplement made through biofermentation rather than extracted from rooster combs. This makes it an important option for patients with known poultry, feather, or egg allergies.
Frequently Asked Questions
How often will Medicare pay for Euflexxa?
Medicare generally covers one Euflexxa treatment course (3 weekly injections) per knee every 6 months. Your provider must document medical necessity each time and that prior treatment provided clinical benefit.
Do I need prior authorization for Euflexxa under Medicare?
No. Original Medicare does not require prior authorization for Euflexxa. Medicare Advantage plans may have their own prior authorization requirements, so check with your plan before scheduling.
Is Euflexxa covered under Medicare Advantage?
Yes. Medicare Advantage plans must cover everything Original Medicare covers. However, your plan may have different cost-sharing, network requirements, or prior authorization rules. Contact your plan directly for details.
What is the difference between Medicare Part B and Part D for injections?
Part B covers medications given by a healthcare provider in a clinical setting, like Euflexxa injections. Part D covers medications you take at home. Since Euflexxa is administered by injection in a medical office, it falls under Part B.
Why would I choose Euflexxa over other HA brands?
Euflexxa is the only non-avian hyaluronic acid injection. If you have allergies to poultry, eggs, or feathers, Euflexxa may be the safest viscosupplementation choice. Discuss your options with your provider.