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  • Aetna Viscosupplementation Precertification Request

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Viscosupplementation Injectable Medication Precertification Request Page 1 of 2 (All fields must be completed and legible for precertification review) Please indicate: Aetna Precertification Notification.

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Medicare typically reimburses physicians for Gel-One Hyaluronate. Medicare covers medically necessary drugs and biologicals when administered incident to a physician's care. In addition, the drug or biological must not usually be considered self-administered.

Least Cost Medically Necessary Brands. ... For Aetna commercial plans, (high molecular weight form of hyaluronic acid), (Hylan G-F 20), and One (Hylan G-F 20) brands of viscosupplement ("least cost brands of viscosupplement") are less costly to Aetna.

Retrospective review is available when: Precertification/notification requirements were met at the time the service was provided, but the dates of service do not match the submitted claim. Aetna converts from secondary payer to primary payer at the time of inpatient claims adjudication.

After an injection, you shouldn't do hard weight-bearing activity for one or two days. Otherwise, you should be able to resume normal activities. Most insurance companies cover hyaluronic acid injections.

The mean payment was US$310 per individual injection and $1128 per patient (covering the 3.6 injections per patient). During the year before TKA, hyaluronic acid injection was the largest treatment expenditure for osteoarthritis (25% of payments).

Medicare and Aetna Medicare won't be responsible either. ... For some services, your PCP is required to obtain prior authorization from Aetna Medicare. You'll need to get a referral from your PCP for covered, non emergency specialty or hospital care, except in an emergency and for certain direct access service.

Generally, Medicare considers -One and to be medically necessary when the patient had documented knee pain due to OA, and has failed to respond to conventional therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs) or other conservative therapies.

As an Aetna Better Health provider, you need to prescribe medically necessary therapy or medications for a member. Some of these services require prior authorization. A current list of the services that require authorization is available via the secure web portal.

Retrospective Authorization. Situations arise where the provider is unable to obtain a pre-authorization before services are delivered or to notify L&I within the specified time period of admission, e.g. 24 hours.

Currently, Medicare will cover hyaluronan injections for the knee only. Medicare also requires X-ray evidence of the knee osteoarthritis.13 Medicare will only cover hyaluronan injections if given no more frequently than every six months. Private insurance may have different rules, so it is always best to check.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232