Hymovis × Prior Authorization

Hymovis Insurance Coverage with Prior Authorization

Everything you need to know about getting Hymovis viscosupplementation injections covered under Prior Authorization, including requirements, costs, and approval steps.

Covered with Requirements

Prior Authorization covers Hymovis when medical necessity and plan requirements are met.

Prior Authorization Required

Coverage Details

Coverage Status

Covered

Prior Authorization

Required

Estimated Cost

$100-$300 with insurance

With insurance

Injection Schedule

2 weekly injections

Can repeat Every 6 months as needed

Prior Authorization for HA Injections

Prior Authorization requires prior authorization before Hymovis injections. Your provider's office typically handles this process. Here's what to expect:

1. Your doctor submits a prior authorization request with clinical documentation
2. Include X-ray evidence and records of failed conservative treatments
3. Approval typically takes 5-15 business days
4. If denied, you have the right to appeal (see below)

Expected Costs

Scenario	Estimated Cost
With Prior Authorization coverage	$100-$300 with insurance
Self-pay (without insurance)	$600-$900 per course (2 injections)
Number of injections	2 weekly injections
Repeat frequency	Every 6 months as needed

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

Other HA Brands & Prior Authorization

Compare how Prior Authorization 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
Gel-One	Single injection	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 Hymovis

See how other insurance plans cover Hymovis:

What Your Doctor Needs to Submit

To get Hymovis approved by Prior Authorization, 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 Hymovis is medically necessary for this patient, including why conservative treatments were insufficient.

Prior Authorization Form

Complete the Prior Authorization prior authorization form with all required fields. Include the J-code for Hymovis, units needed, and treatment location. Submit well in advance of the planned injection date.

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

Frequently Asked Questions

Does Prior Authorization cover Hymovis?

Yes, Prior Authorization typically covers Hymovis viscosupplementation injections for knee osteoarthritis when medical necessity is established. Coverage requires meeting specific requirements such as prior authorization and documentation of failed conservative treatments. The estimated cost with insurance is $100-$300 with insurance.

How much does Hymovis cost with Prior Authorization?

With Prior Authorization coverage, the estimated out-of-pocket cost for Hymovis is $100-$300 with insurance. This includes the 2 weekly injections injection schedule. Without insurance, the cost ranges from $600-$900 per course (2 injections). Your actual cost depends on your specific plan's deductible, copay, and coinsurance structure.

Do I need prior authorization for Hymovis with Prior Authorization?

Yes, Prior Authorization requires prior authorization before Hymovis injections. Your doctor's office will submit clinical documentation including your diagnosis, X-ray results, and records of failed conservative treatments. The process typically takes 5-15 business days. Plan ahead so approval is in place before your scheduled injection date.

What is the injection schedule for Hymovis?

Hymovis uses a 2 weekly injections schedule. It is manufactured by Fidia Pharma USA and uses a non-avian (biofermented) hyaluronic acid source with Medium-High molecular weight. Treatment can be repeated Every 6 months as needed.

What if Prior Authorization denies coverage for Hymovis?

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.