Hyaluronic acid derivatives

Benefit: Medical

Notes:

  • Treatment of osteoarthritis of the knee
  • All formulations are not covered for fully funded or self-funded group plans or Medicaid as of January 1, 2017
  • Covered for Medicare without prior authorization

Code(s):

  • Hymovis, Hyalgan or Supartz: J7318, J7320, J7321, J7322, J7329, J7331
  • Euflexxa: J7323
  • Orthovisc: J7324; length of authorization, 3-5 injections
  • Synvisc or Synvisc One: J7325; length of authorization, 1-5 injections
  • Gel-One: J7326
  • Monovisc: J7327
  • Gel-Syn: J7328 (0.1mg)
  • GelVisc: Q9980 (1mg)