Gel-One × Medicaid

Gel-One Insurance Coverage with Medicaid

Everything you need to know about getting Gel-One viscosupplementation injections covered under Medicaid, including requirements, costs, and approval steps.

Not Typically Covered

Medicaid does not typically cover Gel-One. See alternatives and appeal options below.

Coverage Details

Coverage Status

Not Covered

Prior Authorization

Not typically required

Estimated Cost

$700-$1,000 per injection

Self-pay (without coverage)

Injection Schedule

Single injection

Can repeat Every 6 months as needed

Prior Authorization for HA Injections

Prior authorization is generally not required

Medicaid typically does not require prior authorization for Gel-One. However, your provider should verify eligibility and ensure documentation supports medical necessity.

Expected Costs

Scenario	Estimated Cost
Self-pay (without insurance)	$700-$1,000 per injection
Number of injections	Single injection
Repeat frequency	Every 6 months as needed

Costs are estimates and may vary based on your specific plan, location, and provider. Contact Medicaid to verify your exact out-of-pocket costs.

How to Get Approved

If your Gel-One treatment has been denied by Medicaid, here are steps to appeal:

1 Confirm provider is enrolled in Medicaid before visit
2 Verify correct billing codes with provider office
3 File fair hearing if denied despite medical necessity
4 Ask doctor for letter of medical necessity

Common Denial Reasons

Provider not enrolled in Medicaid
Service billed incorrectly
Frequency limits exceeded
Out-of-network provider used

Other HA Brands & Medicaid

Compare how Medicaid covers other viscosupplementation brands:

Brand	Schedule	Source	Cost w/ Insurance	Details
Synvisc-One	Single injection	Avian	$100-$300 with Medicare/insurance	View
Monovisc	Single injection	Avian	$100-$350 with insurance	View
Durolane	Single injection	Non-Avian	$150-$400 with insurance	View
Hymovis	2 weekly injections	Non-Avian	$100-$300 with insurance	View
Euflexxa	3 weekly injections	Non-Avian	$75-$250 with insurance	View
Gelsyn-3	3 weekly injections	Non-Avian	$75-$200 with insurance	View
SynoJoynt	3 weekly injections	Non-Avian	$75-$200 with insurance	View
Orthovisc	3-4 weekly injections	Avian	$100-$250 with insurance	View

Compare Insurance Plans for Gel-One

See how other insurance plans cover Gel-One:

What Your Doctor Needs to Submit

To get Gel-One approved by Medicaid, your doctor's office will need to prepare the following documentation:

Knee Osteoarthritis Diagnosis

Confirmed diagnosis of knee OA using ICD-10 code M17 (or appropriate subcode). The documentation should include clinical findings from physical examination.

X-Ray Evidence

Radiographic imaging showing joint space narrowing, osteophytes, or other degenerative changes consistent with knee osteoarthritis. Images should be recent (within 6-12 months).

Failed Conservative Treatment

Records showing the patient tried and failed conservative treatments for at least 3-6 months. This includes physical therapy, exercise, weight management, OTC pain medications, and/or prescription anti-inflammatories.

Letter of Medical Necessity

A written statement from the treating physician explaining why Gel-One is medically necessary for this patient, including why conservative treatments were insufficient.

Prior Authorization Form

While prior authorization may not be required, having documentation ready helps avoid delays. Include the appropriate J-code for Gel-One and supporting clinical information.

Tip: Ask your doctor's office to confirm they have all required documentation before submitting to Medicaid. Incomplete submissions are the most common reason for delays and initial denials.

Frequently Asked Questions

Does Medicaid cover Gel-One?

Gel-One is not typically covered by Medicaid. The self-pay cost ranges from $700-$1,000 per injection. You may want to appeal the denial with supporting documentation from your doctor, or consider alternative brands that may be covered.

How much does Gel-One cost with Medicaid?

Since Medicaid does not typically cover Gel-One, you would pay the full self-pay cost of $700-$1,000 per injection for the Single injection injection schedule. You can repeat treatment Every 6 months as needed. Ask your doctor about covered alternatives or consider filing an appeal.

Do I need prior authorization for Gel-One with Medicaid?

Medicaid generally does not require prior authorization for Gel-One. However, your provider should verify your eligibility and ensure documentation supports medical necessity. Requirements can vary by specific plan, so it is always wise to confirm with your insurance before scheduling.

What is the injection schedule for Gel-One?

Gel-One uses a Single injection schedule. It is manufactured by Zimmer Biomet and uses a avian (bird-derived) hyaluronic acid source with High molecular weight. Treatment can be repeated Every 6 months as needed.

What if Medicaid denies coverage for Gel-One?

If denied, you have the right to appeal. Ask for the denial reason in writing, then work with your doctor to submit an appeal including X-ray evidence of osteoarthritis, documentation of at least 3-6 months of failed conservative treatments (physical therapy, OTC pain relievers, exercise), and a letter of medical necessity from your doctor. Many initially denied claims are approved on appeal. You can also ask about alternative covered brands.