Medicare Part B Coverage for Joint Pain Treatments

What Is Medicare Part B?

Medicare Part B is the part of Medicare that covers outpatient medical services. This includes doctor visits, lab tests, and many treatments for joint pain. If you have knee or hip pain from arthritis, Part B likely covers several treatment options.

Part B is different from Part A, which covers hospital stays. Most joint pain treatments happen in a doctor’s office or outpatient clinic. That means Part B is usually the coverage that matters most for you.

What Joint Pain Treatments Does Part B Cover?

Hyaluronic Acid Injection Coverage Details

Hyaluronic acid (HA) injections are also called gel shots or viscosupplementation. Medicare Part B has covered these injections for knee arthritis since 1997. This makes it one of the most stable and reliable coverage options.

Requirements for Coverage

To get Medicare to pay for HA injections, you need:

1. A diagnosis of knee osteoarthritis - Your doctor must confirm you have arthritis with an exam and X-rays
2. Proof that other treatments did not work - You must have tried things like pain medicine, exercise, or physical therapy first
3. A Medicare-approved provider - Your doctor must accept Medicare and bill Medicare directly

No Prior Authorization Needed

Unlike many private insurance plans, Medicare Part B does not require prior authorization for HA injections. This means your doctor does not need to get approval before the treatment. They simply need to document that you meet the medical requirements.

All FDA-Approved Brands Are Covered

Medicare covers all FDA-approved HA products, including:

Physical Therapy Coverage Under Part B

Medicare Part B covers physical therapy when your doctor orders it. PT can help reduce joint pain and improve how well you move.

What You Need to Know

• Referral required - Your doctor must write an order for PT
• Must be medically necessary - The therapy must treat a specific condition
• No strict visit limit - Medicare removed the hard cap on PT visits, but high-cost cases may get extra review
• Covered at 80% - You pay 20% of the approved amount after your deductible

Physical therapy is often required before Medicare will approve other treatments like injections. Keep records of your PT sessions.

What Is NOT Covered by Part B

Some popular treatments for joint pain are not covered by Medicare. If you get these treatments, you will pay the full cost yourself.

PRP Injections

Platelet-rich plasma (PRP) uses your own blood to try to heal joints. Medicare considers PRP experimental. You will pay 100% out of pocket, which can be $500 to $2,000 per injection.

Stem Cell Treatments

Stem cell injections are not covered by Medicare. Many clinics charge $5,000 to $15,000 for these treatments. Be careful of clinics that promise to “regenerate” cartilage. These claims are often not backed by strong research.

Cost Breakdown: What You Will Pay

Understanding your costs helps you plan for treatment. Here is what to expect with Original Medicare (Part B):

Your Part B Costs

Example: HA Injection Cost

If Medicare approves $600 for an HA injection series:

• Medicare pays: $480 (80%)
• You pay: $120 (20%)

If you have not met your deductible yet, you pay that first.

Medicare vs. Self-Pay: Cost Comparison

This table shows why Medicare coverage matters. Without insurance, joint pain treatments cost much more.

Key point: With Medicare, you save hundreds to thousands of dollars on covered treatments.

Prior Authorization: What You Need to Know

Medicare Advantage May Be Different

If you have Medicare Advantage (Part C) instead of Original Medicare, your plan may require prior authorization. Always check with your specific plan before treatment.

Tips for Getting Your Treatment Covered

Follow these steps to make sure Medicare pays for your treatment:

Before Treatment

1. Verify your provider accepts Medicare assignment - Ask the office directly
2. Make sure your deductible status is current - Call Medicare or check MyMedicare.gov
3. Keep records of treatments you have tried - PT sessions, medications, exercises
4. Get recent X-rays - Within the past 12 months

During Treatment

5. Ask for an itemized bill - Make sure codes are correct
6. Keep copies of all paperwork - You may need them later

If You Are Denied

7. Request the denial reason in writing - You need specifics to appeal
8. File your appeal within 120 days - Do not wait
9. Have your doctor write a letter - Explain why treatment is medically necessary

Common Denial Reasons and How to Avoid Them

Questions to Ask Your Doctor

Before getting treatment, ask these questions:

1. “Do you accept Medicare assignment?”
2. “What will my out-of-pocket cost be?”
3. “Is my conservative treatment documented in my records?”
4. “Do I have recent X-rays showing my arthritis?”
5. “Will you handle the Medicare billing?”

Medigap and Medicare Supplement Plans

If you have a Medigap policy, it may cover your 20% coinsurance. Some plans also cover the Part B deductible. Check your specific plan to see what extra coverage you have.

Common Medigap plans that help with Part B costs:

• Plan G - Covers 20% coinsurance
• Plan N - Covers most coinsurance with small copays

Key Takeaways

Related Resources

• Medicare Coverage for Gel Injections: 2026 Update
• Hyaluronic Acid Injections: Complete Guide
• Medicare Coverage Overview
• Physical Therapy Coverage Under Medicare
• Understanding Medicare Advantage vs. Original Medicare