Does Medicare Cover Viscosupplementation Injections?

After many years of supporting our weight, our knees often deteriorate or weaken. And because of that, older people are more prone to developing conditions like osteoarthritis. They are also more likely to have knee injuries. Viscosupplementation injections are one way to treat some knee problems without undergoing knee surgery.

If you have knee problems, you may be wondering, “does Medicare cover viscosupplementation injections?” In this article, we answer that question in clear, plain English. You will also find the average costs of viscosupplementation injections and other helpful info.

Does Medicare Cover Viscosupplementation Injections?

The short answer is yes; Medicare will cover the cost of viscosupplementation 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 viscosupplementation 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 viscosupplementation injections. Coverage for viscosupplementation injections, or Hyaluronic Acid Injections, is provided by Medicare Part B. Medicare Part B 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 viscosupplementation injections, it must be 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 you are approved, Medicare Part B will provide coverage for one viscosupplementation injection every 6 months.

Medicare Part B also provides coverage for Corticosteroid injections and Placental Tissue Matrix (PTM) injections under the same conditions for Hyaluronic Acid Injections. However, Medicare Part B does not provide coverage for Platelet-Rich Plasma (PRP) injections.

Part C Coverage for Viscosupplementation Injections

Medicare Advantage plans (Medicare Part C) also provide coverage for viscosupplementation injections. Advantage plans must cover everything Original Medicare covers. Though they also offer some additional benefits. However, what each plan covers and how much the out-of-pocket costs are vary depending on the plan you have.

How Much Do Viscosupplementation Injections Cost?

The lowest price for a viscosupplementation injection averages around $420 which is for the medication Genvisc 850. The most expensive viscosupplementation injection is Monovisc, which can cost around $1,500. Aside from these two, the price of a viscosupplementation injection typically range from $590 to $1,500. The price varies depending on the brand.

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.