Does Medicare Cover Knee Pain Treatments?

One of the first questions patients ask when diagnosed with knee osteoarthritis is: “Will my insurance cover treatment?” If you have Medicare, you’ll be glad to know that most knee pain treatments are covered. Here’s what you need to know.

Quick Answer: What Does Medicare Cover?

Medicare Part B covers most outpatient knee osteoarthritis treatments, including:

• Hyaluronic acid (gel) injections - Covered for knee OA
• Cortisone injections - Covered when medically necessary
• Physical therapy - Covered with no visit limit
• Doctor visits - Covered for diagnosis and follow-up
• X-rays and imaging - Covered for diagnosis
• Knee replacement surgery - Covered when criteria are met

You typically pay 20% of the Medicare-approved amount after meeting your Part B deductible ($240 in 2024).

Treatment-by-Treatment Coverage Guide

Hyaluronic Acid (Gel) Injections

Coverage: Medicare Part B covers HA injections for knee osteoarthritis.

What you’ll pay:

• 20% of the Medicare-approved amount
• Typically $30-$80 per injection after deductible
• Series of 1-5 injections depending on the brand

Requirements:

• Diagnosis of knee osteoarthritis (ICD-10 code required)
• Documentation that you’ve tried other treatments (NSAIDs, physical therapy)
• Injection administered in a medical setting

Covered brands include: Synvisc-One, Euflexxa, Supartz, Hyalgan, Orthovisc, Gel-One, Monovisc, Durolane, and others.

Learn more about hyaluronic acid injections and whether you might be a candidate.

Cortisone (Steroid) Injections

Coverage: Medicare Part B covers cortisone injections for joint pain.

What you’ll pay:

• 20% of the Medicare-approved amount
• Usually $20-$40 per injection after deductible

Limitations:

• Generally limited to 3-4 injections per joint per year
• Long-term use not recommended due to potential cartilage damage

Physical Therapy

Coverage: Medicare Part B covers outpatient physical therapy with no annual visit cap for medically necessary treatment.

What you’ll pay:

• 20% of the Medicare-approved amount
• Average $20-$50 per session after deductible

Requirements:

• Referral from your doctor (in most cases)
• Treatment must be medically necessary
• Must show improvement to continue coverage

Note: While there’s no hard visit limit, your therapist must document ongoing medical necessity. Maintenance therapy (to prevent decline rather than improve) has different coverage rules.

Doctor Visits and Diagnostics

Coverage: Medicare Part B covers:

• Initial evaluation and diagnosis
• Follow-up visits
• X-rays (diagnostic imaging)
• MRI when medically necessary

What you’ll pay:

• 20% of Medicare-approved amounts
• Specialist visits may cost more than primary care

Knee Replacement Surgery

Coverage: Medicare covers knee replacement surgery (partial or total) when conservative treatments have failed.

What you’ll pay:

• Part A covers hospital stay
• Part B covers surgeon and anesthesiologist fees
• You pay the Part A deductible plus 20% of Part B services

Requirements:

• Documentation that conservative treatments were tried (typically 3-6 months)
• Significant pain and functional limitation
• X-ray evidence of joint damage

Understanding Your Out-of-Pocket Costs

With Original Medicare (Parts A & B)

With Medicare Advantage

Costs vary by plan. Many Medicare Advantage plans offer:

• Lower or $0 copays for some services
• Maximum out-of-pocket limits
• Additional benefits like transportation to appointments

Important: Some Advantage plans require prior authorization for certain treatments. Check with your plan before scheduling.

Medigap (Supplement) Coverage

If you have a Medigap policy, it may cover:

• Your 20% coinsurance
• Part B deductible (depending on your plan)

With comprehensive Medigap coverage, many knee treatments can cost you little to nothing out of pocket.

Tips to Reduce Your Costs

1. Use Providers Who Accept Medicare Assignment

Providers who “accept assignment” agree to Medicare’s approved amount as full payment. They can only charge you the 20% coinsurance.

Red flag: If a provider says they don’t accept Medicare assignment, you could pay more. Always ask before your appointment.

2. Ask About Generic Alternatives

For HA injections, ask your doctor about FDA-approved options at different price points. The Medicare-approved amount varies by brand.

3. Get Everything Documented

Coverage depends on documentation. Make sure your doctor notes:

• Your diagnosis
• Previous treatments you’ve tried
• Why this treatment is medically necessary
• Your functional limitations

4. Use the Medicare Coverage Determination Process

If a treatment is denied, you can appeal. Many denials are overturned when proper documentation is submitted.

5. Consider Your Medigap Options

If you don’t have supplemental coverage, the 20% coinsurance for a treatment series can add up. A Medigap plan or Medicare Advantage plan might reduce your total costs.

Common Medicare Coverage Questions

Does Medicare require prior authorization for knee injections?

Original Medicare: Generally no prior authorization is needed for HA or cortisone injections. However, your doctor must document medical necessity.

Medicare Advantage: Prior authorization requirements vary by plan. Check your plan’s formulary and authorization requirements.

How many gel injections will Medicare cover?

Medicare covers the full course of treatment as prescribed - whether that’s 1, 3, or 5 injections depending on the brand used. Most single-injection brands (like Synvisc-One) can be repeated after 6 months if needed.

Is there a waiting period between injection series?

Medicare doesn’t have a strict waiting period, but most HA injection protocols recommend waiting 6 months between series for the same knee. Your doctor will determine what’s medically appropriate.

What if my treatment is denied?

You have the right to appeal. Steps:

1. Ask your doctor to submit additional documentation
2. Request a redetermination from Medicare
3. If denied again, escalate to higher appeal levels

Many initial denials are reversed on appeal when proper documentation is provided.

What Medicare Doesn’t Cover

Some treatments for knee pain are not covered by Medicare:

• Experimental treatments - PRP (platelet-rich plasma) and stem cell injections are not covered
• Weight loss programs - Unless you qualify for obesity counseling
• Home exercise equipment - Treadmills, exercise bikes, etc.
• Comfort items - Heating pads, massage devices

Some Medicare Advantage plans may offer additional coverage for these items as supplemental benefits.

Finding Medicare-Accepting Providers

Not all providers accept Medicare. To find ones who do:

1. Use Medicare’s provider finder: medicare.gov/care-compare
2. Call ahead: Always verify Medicare acceptance before your appointment
3. Ask about assignment: Confirm they accept Medicare assignment to avoid surprise charges

Browse our provider directory to find joint pain specialists in your area.

Your Next Step

Understanding your coverage is the first step. Now take action:

1. Get diagnosed - If you haven’t already, see a doctor about your knee pain
2. Ask about options - Your doctor can explain which treatments might help
3. Check your specific plan - If you have Medicare Advantage, review your plan details
4. Find a provider - Look for specialists who accept Medicare assignment

Have questions about whether a specific treatment is covered? Take our pain assessment quiz to get personalized guidance, or check your coverage on our insurance guide page.