Does Medicare Cover Knee Gel Injections?
Medicare Benefits Solutions
Mar 16, 2022
If you’re living with osteoarthritis in your knees, you know how difficult and painful it can be. Today in the United States, over 50 million people have osteoarthritis.
When you are living with knee pain, stiffness, loss of flexibility, bone spurs, swelling and tenderness, you may also experience a general reduction in your day-to-day quality of life.
Shots for arthritis in the knee, AKA knee gel injections or hyaluronic acid knee injections, may offer one possible solution.
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Medicare Coverage for Knee Gel Injections
If you have Original Medicare Part B (medical insurance) or a Medicare Advantage (Part C) plan, your benefits include coverage of a knee gel injection if you are eligible.
To meet the requirements for eligibility, you must meet the following requirements:
- The hyaluronic acid injections are for the knees only
- You show evidence of knee osteoarthritis with X-rays
- Coverage is acceptable for gel shots for the knee given no more often than every six months
- Your Medicare-affiliated healthcare provider must certify that the gel knee injections are medically necessary
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What are Knee Gel Injections?
In cases of severe knee osteoarthritis, many physicians may suggest either having knee replacement surgery or treatment with hyaluronic acid injection in the knee. Are you wondering how much do hyaluronic acid knee injections cost and how they put gel in your knee? The gel injection treatment is non-invasive and helps by temporarily relieving the pain and restricted mobility that comes with osteoarthritis.
Top knee injection options for knee pain include:
- cortisone shots
- hyaluronic acid injections such as Synvisc-One
- stem cell therapy
- Botox injections
- platelet rich plasma therapy
Knee gel injections, also known as viscosupplementation, are gels that consist of hyaluronic acid, a substance found naturally in the synovial fluid around all the joints. A supplement of this fluid, injected into the knee, can provide better lubrication and cushioning so the joint bones don’t rub together.
Knee Gel Injections and Other Therapies
Alternative therapies to knee injection gel for knee arthritis, to help manage arthritis and knee pain, include:
- Modifying daily activities
- Low-impact exercise programs such as water aerobics
- Gentle chair yoga for added support
- Nutritional changes to reduce or eliminate inflammatory foods from your diet
In many cases, people dealing with constant pain will eventually require knee replacement surgery. However, getting knee gel injections could be a great option for the short-term relief of your symptoms.
If your healthcare provider has mentioned knee gel injections as a treatment option to limit pain and increase mobility, you might be concerned about your Medicare insurance coverage. To meet the requirement of medical necessity, certain conditions apply. You are experiencing knee pain due to osteoarthritis, regardless of whether the pain is accompanied by stiffness and swelling.
TIP: Discover tips for modifying daily activities when you have bad knees.
Knee Pain and Medicare Benefits
Your Medicare Part B benefits cover the cost of your knee gel injections if the administering health care provider accepts Medicare assignment and they are given in their medical facility or office or as an outpatient in a hospital. The healthcare provider who administers the hyaluronic acid injections knee is the one who purchases the medication, you don’t buy it yourself.
To meet the requirement of medical necessity, certain conditions apply. You are experiencing knee pain due to osteoarthritis, regardless of whether the pain is accompanied by stiffness and swelling. Knee pain doesn’t respond to other forms of therapy like weight loss or physical therapy. Knee pain doesn’t respond to over-the-counter drugs like nonsteroidal anti-inflammatory medications.
Your Medicare Part B benefits cover the cost of your knee gel injections if the administering health care provider accepts Medicare assignment and they are given in their medical facility or office or as an outpatient in a hospital. The healthcare provider who administers the injections is the one who purchases the medication, you don’t buy it yourself.
Your Medicare Part B benefits cover 80 percent of the final, approved cost of the injections and their administration. You pay the remaining 20 percent as well as your Part B deductible.
If you have coverage with a Medicare Advantage plan, in most cases you must use health care providers, medical facilities, hospitals, and pharmacies that are within your private insurance plan’s network. If you go outside the network, you may have to pay 100 percent of the cost. If you don’t know who is included in the plan’s network, read the policy carefully, or call your provider and ask a representative there.
TIP: Find out which plans offer the best benefits for knee gel injections and compare them against your current coverage.
Cost of Knee Gel Injections Without Insurance
Are you wondering how much knee gel injections cost without Medicare insurance? There are several brands of knee gel injections on the market these days. Your Synvisc 3 injections out-of-pocket cost per injection depends first on the brand you choose. Your cost also depends on where you live and who administers your injection. In the United States, the estimated national average cost for one knee gel injection is $1,012.00.
If your health care provider recommends that you get gel injections to relieve your knee pain and mobility issues, you should do your homework and make a decision based on what’s best for your circumstances. If you have more questions about your Medicare coverage for the injections, you can speak to your physician or a representative of your Medicare plan.
TIP: Find out if your existing Medicare plan covers knee gel injections.
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