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  • Hyaluronic Acid Derivatives Prior Authorization Request Form

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OptumRx has partnered with CoverMyMeds to receive prior authorization requests, saving you time and often delivering realtime determinations. Visit go.covermymeds.com/OptumRx to begin using this free.

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Generally, hyaluronic acid injections can cost anywhere from $200 to a few thousand dollars. This may also depend on the number of injections required and how frequently you need them.

Hyaluronic acid derivatives are indicated for the treatment of pain related to knee osteoarthritis in patients who have failed to respond adequately to conservative nonpharmacologic therapy and to simple analgesics (e.g., acetaminophen).

If medically necessary, Medicare will reimburse the cost of hyaluronic acid injections for osteoarthritis of the knee. However, it does not cover other forms of osteoarthritis, such as for the hip or shoulder.

Medicare will cover knee injections once every six months if they are medically necessary. The injections are covered under Medicare Part B and subject to the annual Part B deductible.

knee per 180 days) NDC. . J7318. 1 mg. 60 mg/3 mL.

No. In general, Medicare prescription drug plans (Part D) do not cover this drug. Be sure to contact your specific plan to verify coverage information. A limited set of drugs administered in a doctor's office or hospital outpatient setting may be covered under Medical Insurance (Part B).

For example, hyaluronic acid injections cost $822 per patient, physical therapy cost $405 and a knee brace cost $344.

Group 1 CodeDescriptionJ7323HYALURONAN OR DERIVATIVE, , FOR INTRA-ARTICULAR INJECTION, PER DOSEJ7324HYALURONAN OR DERIVATIVE, , FOR INTRA-ARTICULAR INJECTION, PER DOSEJ7325HYALURONAN OR DERIVATIVE, OR -ONE, FOR INTRA-ARTICULAR INJECTION, 1 MG10 more rows

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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