Medicare Coverage for Hyaluronic Acid Injections
Yes, Medicare Part B covers hyaluronic acid (HA) injections for knee osteoarthritis when medical necessity criteria are met. This coverage has been stable since 1997, making Medicare one of the most reliable payers for viscosupplementation.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Covered? | Yes, under Part B |
| Prior Authorization | Generally not required |
| Your Cost | 20% coinsurance after $240 deductible |
| Typical Out-of-Pocket | $60-$150 per injection series |
| Frequency Allowed | Every 6 months per knee |
What Medicare Requires for Coverage
1. Documented Osteoarthritis Diagnosis
Medicare requires objective evidence of knee osteoarthritis:
- X-ray findings showing joint space narrowing, osteophytes, or subchondral sclerosis
- Clinical documentation of OA symptoms in medical records
- Correct ICD-10 codes (M17.11, M17.12, M17.0)
2. Failed Conservative Treatment
Before approving HA injections, Medicare expects documentation that you’ve tried:
- Physical therapy (typically 4-6 weeks)
- Oral medications (NSAIDs, acetaminophen)
- Activity modification (weight management, low-impact exercise)
- Other non-surgical approaches that proved insufficient
3. Medical Necessity
Your provider must document why HA injections are medically appropriate for your specific situation, including:
- Severity of symptoms
- Impact on daily function
- Why other treatments haven’t worked
- Expected benefits from viscosupplementation
What You’ll Pay
With Original Medicare (Part A and Part B):
- Annual Deductible: $240 (2025)
- Coinsurance: 20% of Medicare-approved amount
- Typical Total Cost: $60-$150 per injection series
Example Calculation:
- Medicare-approved amount: $600
- Medicare pays: $480 (80%)
- You pay: $120 (20%)
Medigap Coverage
If you have a Medicare Supplement (Medigap) policy:
- Plans may cover the 20% coinsurance
- Some plans cover the Part B deductible
- Check your specific plan details
Medicare Advantage
If you have Medicare Advantage (Part C):
- Coverage follows Original Medicare guidelines
- Copays may vary by plan
- Prior authorization may be required
- Network restrictions may apply
How to Ensure Coverage
Before Your Appointment
- Verify provider accepts Medicare assignment
- Confirm your Part B deductible status
- Ensure X-rays are recent (within 12 months)
- Have conservative treatment documented in your records
At Your Appointment
- Confirm correct coding (diagnosis + procedure)
- Get itemized statement showing charges
If Denied
- Request written denial reason
- File appeal within 120 days
- Include supporting documentation
All FDA-Approved HA Brands Are Covered
Medicare covers all FDA-approved hyaluronic acid products for knee OA:
| Brand | Injections | Covered |
|---|---|---|
| Synvisc-One | 1 | ✓ |
| Monovisc | 1 | ✓ |
| Durolane | 1 | ✓ |
| Gel-One | 1 | ✓ |
| Euflexxa | 3 | ✓ |
| Supartz | 3-5 | ✓ |
| Hyalgan | 3-5 | ✓ |
| Orthovisc | 3-4 | ✓ |
Why Medicare Coverage Matters
While some commercial insurers are reducing HA coverage, Medicare’s coverage has remained stable for nearly three decades. This reflects federal recognition that viscosupplementation is a medically necessary treatment option for knee osteoarthritis.