Does Medicare Cover Durolane Injections?

Durolane is a single injection medication used in treating osteoarthritis. Osteoarthritis is a common condition among seniors and one of the ways to treat it is through knee-gel injections such as Durolane. But Durolane injections can be expensive and not everyone who needs them can easily afford them.

For those who can benefit from this treatment, a common question becomes, “does Medicare cover Durolane injections?” In this article, we answer that question in clear, plain English. You will also find the average costs of Durolane injections and other helpful info.

Does Medicare Cover Durolane Injections?

The short answer is yes; Medicare will cover the cost of Durolane injections. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Durolane injections. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for Durolane injections. Durolane is a brand of hyaluronic acid injection, or viscosupplementation injection, which Medicare Part B covers. Coverage for Durolane and other hyaluronic acid injections is provided by Medicare Part B.

Aside from viscosupplementation injections, Medicare Part B also provides coverage for many types of knee gel injections as long as they are approved by the FDA.

For Medicare Part B to provide coverage for your Durolane injections, it must be first considered medically necessary to treat a condition such as osteoarthritis. You will also need to undergo an x-ray to show that you have osteoarthritis for Medicare Part B to provide coverage.

Once approved by Medicare Part B, they will provide coverage for one Durolane injection every 6 months.

Medicare Part B also provides coverage for corticosteroid injections and placental tissue matrix, or PTM, injections under the same conditions for hyaluronic acid injections. However, Medicare Part B does not provide coverage for platelet-rich plasma, or PRP, injections.

Part C Coverage for Durolane Injections

Medicare Advantage plans (Medicare Part C) also provide coverage for Durolane injections. It’s a requirement for Part C plans to cover everything Original Medicare covers. However, these plans will offer additional benefits as well. Exactly what additional benefits a plan covers and how much the costs are for these benefits depend on the specific plan.

How Much Do Durolane Injections Cost?

3 counts of 60mg/3ml of Durolane injections may range somewhere from $1,100 to $2,000 or even more. This price varies depending on the provider.

What Are The Benefits Of Durolane Injections To People Who Are Suffering From Osteoarthritis?

Since it is an injection for osteoarthritis, the intended benefit of this injection is that it will help in treating the affected joint. One great benefit of this medication or these types of medications is that they can help in delaying knee replacement surgery.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.