Does Medicare Cover Synvisc-One?

Medicare Benefits Solutions
Feb 17, 2021

Synvisc-One is a prescription injection-type medication that your healthcare professional may prescribe to treat knee pain. The injection directly into the knee is administered by a medical professional in an outpatient setting.

If prescribed, you’ll get the injection once a week for three consecutive weeks. Knee gel injections can help reduce knee pain by lubricating and cushioning the joint. The active ingredient in this injection is hyaluronate. If you have Medicare benefits, you may wonder whether or not you have coverage for the cost of your injection series.

Medicare Coverage for Synvisc-One

If your doctor provides documentation that shows the injections are medically necessary to help alleviate knee pain due to osteoarthritis, you could get coverage under Medicare Part B. You’ll also have to try some conventional therapies and have them fail before Medicare will approve the use of this drug. Therapy using non-steroidal anti-inflammatory drugs, such as Ibuprofen and Aspirin for non-prescription drugs and Naproxen or Etodolac for prescription drugs, may be suggested before covering Synvisc-One.  

The facility and doctor where you get the injection must accept Medicare assignment. If they don’t, Medicare won’t cover the costs of the procedure, and you may have to pay out-of-pocket.

If you choose to enroll in a Medicare Advantage plan, you’ll get the same level of coverage that you’d get under Original Medicare. MA plans will cover Synvisc-One injections if you have tried more conventional therapies and don’t get relief, as long as your doctor documents that it’s medically necessary. 

Average Cost for Synvisc-One

With your Medicare benefits, your coverage amount will vary. It’s a good idea to contact your specific plan provider and ask for details. If Medicare Part B covers this treatment, they’ll typically cover it at 80% of the Medicare-approved rate. You’ll have to pay the Part B copayment and coinsurance amount, and this is the remaining 20% of the Medicare-approved cost. You also have to meet the Part B deductible, and this is $203 for 2021. 

If your Medicare doesn’t cover it, you could expect to pay around $1,062 per shot. Since this is a triple-shot treatment, your total cost just for the medications is $3,186. This doesn’t include the facility fee or doctor charge so, it can get very expensive in a short amount of time.

Side Effects of Synvisc-One

The good news is that the reported side effects for these injections are on the mild side. They tend to go away by themselves after a few days. You could experience skin discoloration at the injection site, stiffness, swelling, bruising, and mild pain by or in your knee. 

General Information

This injection isn’t considered to be appropriate for people who have already had a knee joint infection or a skin disease in the area where the doctor does the injection. After you get the injection, you should avoid heavy activity for 48 hours. Your doctor will give you detailed instructions. Do not stand for more than an hour at a time for the first 48 hours after you get the injection to prevent side effects from occurring.

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