Hyaluronic Acid/Viscosupplementation

Hyaluronic acid is a naturally occurring component of synovial fluid and cartilage within our joints. Its viscous nature is thought to act as a lubricant, with its elasticity acting as a shock absorber. In patients with osteoarthritic joints, most commonly the knee(s), the availability of this substance is reduced, making them more susceptible to damage. Viscosupplementation is the act of injecting hyaluronic acid or hyaluronan as a means of treating osteoarthritic joints. These products have several brand names. This updated coverage decision adds new brand names that are currently on the market.

Coverage decision: Covered with conditions (Effective date: June 1, 2014; last updated*: February 2019).

Authorization requirements


Is authorization required?

How do I get pre-authorization?

Yes

L&I (State fund):
Complete the Preauthorization Form and fax to (360) 902-4567

Self-insured:
Contact the employer or its third party administrator

 

Regulatory authority and related information

*Four new products (Durolane, GenVisc 850, TriVisc and Visco-3) are included. The billing and product information can be found in Fee Schedules and Payment Policies (MARFS).

 

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