Monovisc × Anthem Blue Cross

Monovisc Insurance Coverage with Anthem Blue Cross

Everything you need to know about getting Monovisc viscosupplementation injections covered under Anthem Blue Cross, including requirements, costs, and approval steps.

Not Typically Covered

Anthem Blue Cross does not typically cover Monovisc. See alternatives and appeal options below.

Coverage Details

Coverage Status

Not Covered

Prior Authorization

Not typically required

Estimated Cost

$700-$1,100 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

Anthem Blue Cross typically does not require prior authorization for Monovisc. However, your provider should verify eligibility and ensure documentation supports medical necessity.

Expected Costs

Scenario	Estimated Cost
Self-pay (without insurance)	$700-$1,100 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 Anthem Blue Cross to verify your exact out-of-pocket costs.

How to Get Approved

If your Monovisc treatment has been denied by Anthem Blue Cross, here are steps to appeal:

1 Get a physician prescription before ordering any brace
2 Use an in-network DME supplier
3 Request prior authorization for custom braces before ordering
4 Document how the brace supports your treatment plan

Common Denial Reasons

No physician prescription
Out-of-network DME supplier
Custom brace ordered without prior authorization
Insufficient medical necessity documentation

Other HA Brands & Anthem Blue Cross

Compare how Anthem Blue Cross covers other viscosupplementation brands:

Brand	Schedule	Source	Cost w/ Insurance	Details
Synvisc-One	Single injection	Avian	$100-$300 with Medicare/insurance	View
Durolane	Single injection	Non-Avian	$150-$400 with insurance	View
Gel-One	Single injection	Avian	$100-$300 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 Monovisc

See how other insurance plans cover Monovisc:

What Your Doctor Needs to Submit

To get Monovisc approved by Anthem Blue Cross, 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 Monovisc 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 Monovisc and supporting clinical information.

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

Frequently Asked Questions

Does Anthem Blue Cross cover Monovisc?

Monovisc is not typically covered by Anthem Blue Cross. The self-pay cost ranges from $700-$1,100 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 Monovisc cost with Anthem Blue Cross?

Since Anthem Blue Cross does not typically cover Monovisc, you would pay the full self-pay cost of $700-$1,100 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 Monovisc with Anthem Blue Cross?

Anthem Blue Cross generally does not require prior authorization for Monovisc. 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 Monovisc?

Monovisc uses a Single injection schedule. It is manufactured by DePuy Synthes (Johnson & Johnson) and uses a avian (bird-derived) hyaluronic acid source with High (1,000-2,900 kDa) molecular weight. Treatment can be repeated Every 6 months as needed.

What if Anthem Blue Cross denies coverage for Monovisc?

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.