Orthovisc × Out Of Pocket Costs

Orthovisc Insurance Coverage with Out Of Pocket Costs

Everything you need to know about getting Orthovisc viscosupplementation injections covered under Out Of Pocket Costs, including requirements, costs, and approval steps.

Typically Covered

Out Of Pocket Costs typically covers Orthovisc for knee osteoarthritis.

Coverage Details

Coverage Status

Covered

Prior Authorization

Not typically required

Estimated Cost

$100-$250 with insurance

With insurance

Injection Schedule

3-4 weekly injections

Can repeat Every 6-12 months as needed

Prior Authorization for HA Injections

Prior authorization is generally not required

Out Of Pocket Costs typically does not require prior authorization for Orthovisc. However, your provider should verify eligibility and ensure documentation supports medical necessity.

Expected Costs

Scenario	Estimated Cost
With Out Of Pocket Costs coverage	$100-$250 with insurance
Self-pay (without insurance)	$600-$900 per course (3 injections)
Number of injections	3-4 weekly injections
Repeat frequency	Every 6-12 months as needed

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

Other HA Brands & Out Of Pocket Costs

Compare how Out Of Pocket Costs 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
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

Compare Insurance Plans for Orthovisc

See how other insurance plans cover Orthovisc:

What Your Doctor Needs to Submit

To get Orthovisc approved by Out Of Pocket Costs, 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 Orthovisc 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 Orthovisc and supporting clinical information.

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

Frequently Asked Questions

Does Out Of Pocket Costs cover Orthovisc?

Yes, Out Of Pocket Costs typically covers Orthovisc viscosupplementation injections for knee osteoarthritis when medical necessity is established. Coverage is generally straightforward when prescribed by your doctor. The estimated cost with insurance is $100-$250 with insurance.

How much does Orthovisc cost with Out Of Pocket Costs?

With Out Of Pocket Costs coverage, the estimated out-of-pocket cost for Orthovisc is $100-$250 with insurance. This includes the 3-4 weekly injections injection schedule. Without insurance, the cost ranges from $600-$900 per course (3 injections). Your actual cost depends on your specific plan's deductible, copay, and coinsurance structure.

Do I need prior authorization for Orthovisc with Out Of Pocket Costs?

Out Of Pocket Costs generally does not require prior authorization for Orthovisc. 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 Orthovisc?

Orthovisc uses a 3-4 weekly injections 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 6-12 months as needed.

What if Out Of Pocket Costs denies coverage for Orthovisc?

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.