Coverage Verification

Medicare Coverage Checklist

Good news: Medicare has covered viscosupplementation (gel injections) for knee osteoarthritis since 1997. With just 3 simple requirements, you may qualify for this non-surgical treatment that provides 6-12 months of relief.

The 3 Requirements for Medicare Coverage:

Confirmed Diagnosis

X-ray showing knee osteoarthritis

Failed Conservative Care

PT, NSAIDs, or other treatments tried

Active Medicare Part B

Coverage for outpatient services

Medicare: 1-800-MEDICARE (1-800-633-4227)

Important: Verify Before Treatment

Medicare coverage rules can change, and individual situations vary. Always verify coverage with Medicare directly (1-800-633-4227) and your provider's billing department before receiving treatment. This checklist is for guidance only and does not guarantee coverage.

Medicare Coverage Verification

Work through each section to verify your coverage. Check off items as you confirm them.

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Medicare Coverage Quick Facts

What Medicare Covers

✓ Hyaluronic acid injections for knee OA
✓ Corticosteroid injections
✓ X-rays and imaging
✓ Office visits with accepted providers
✓ Physical therapy (with limits)

What Medicare Typically Doesn't Cover

✗ PRP (Platelet-Rich Plasma) injections
✗ Stem cell treatments
✗ Experimental treatments
✗ HA injections for non-knee joints (usually)
✗ Treatments without documented medical necessity

Traditional Medicare Costs

Deductible: $240/year (2024)
Coinsurance: 20% of approved amount
Typical HA injection cost: $100-$300 per knee
With Medigap: Often $0 after deductible

Medicare Advantage Notes

• Coverage varies significantly by plan
• May require prior authorization
• Must use in-network providers
• Copays vary—check your specific plan
• Call the number on your card to verify

Not Sure If You're a Candidate?

Take our 3-minute Knee Health Score Quiz to find out if you may qualify for Medicare-covered gel therapy based on your symptoms, treatment history, and insurance.

Take the Knee Health Score Quiz