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To be eligible for coverage, the knee gel injection must be administered by a Medicare-approved provider and meet certain criteria. For example, the individual must have a diagnosis of knee osteoarthritis and have documented evidence of functional impairment or pain.
For Medicare recipients, drugs typically fall under Part D, and Medicare recipients have the option of enrolling for prescription drug insurance when they become eligible for Medicare. However, knee injections are typically administered by a physician in a medical office or clinic.
Under Medicare Part B, you're usually responsible for 20% of the cost of knee injections, with Medicare paying the remaining 80%. Under Medicare Part C , you'll likely have to pay a copay or coinsurance.
Knee gel injections are injections of hyaluronic acid, a viscous substance found naturally in your joints. Gel injections can help replace the lost lubrication in your knee joint when you have arthritis.
Use this page to view details for the Local Coverage Determination for Hyaluronic Acid Injections for Knee Osteoarthritis.
Medicare covers medical devices recommended by your doctor. For arthritis, your doctor may prescribe anti-inflammatory drugs, joint injections, or other medications that ease joint discomfort.
Does Medicare Pay for Knee Gel Injections? Yes, Medicare will cover knee injections that approved by the FDA. This includes hyaluronan injections. Medicare does require that the doctor took x-rays to show osteoarthritis in the knee. The coverage is good for one injection every 6 months.
Medicare-Approved Provider: Make sure your injections are done by a provider who accepts Medicare assignment. Otherwise your wallet might feel the pain more than your knee.
For injections to be covered, you must show evidence of knee osteoarthritis with X-rays, and you may be limited to a certain number of injections per year. You would pay 20% of the Medicare-approved amount for these injections after meeting the Part B deductible ($226 in 2023).
Medicare Part B is the most common part of Medicare benefits used to pay for knee gel injections. Outpatient insurance through Medicare Part B pays for 80% of approved expenses, but Medicare recipients will need to maintain coverage by paying a monthly premium. Medicare Part B also requires you to meet an annual deductible before benefits apply.