Genvisc 850 is only for injection into the knee, performed by a qualified. Viscosupplementation for knee pain viscosupplementation is a nonsurgical procedure for patients suffering with knee pain due to osteoarthritis. Hyaluronic acid also known as hyaluron and hyaluronate is a natural substance normally found in the synovial fluid of our joints. Viscosupplementation therapy for knee cpt code 20610, j7321. Viscosupplementation for the treatment of knee arthritis. Intraarticular injections of hyaluronan inj 033 billing and coding guidelines. The synvisc one brand of this medicine is given only once. For patients with osteoarthritis of the knee, the addition of manual physical therapy as an adjunct to traditional. The primary objective of the repeat treatment phase was to evaluate safety in patients receiving a second repeat ia treatment of 6ml of synvisc one at 26 weeks following the first course of treatment. Hcpcs code j7321, j7323, and j7324 are per dose codes. The injection is routinely given under the guidance of ultrasound to ensure that the.
Hyaluronans, viscosupplementation for osteoarthritis of. Final evidence report page iii key abbreviations acronyms ha, hyaluronic acid sometimes used to refer to all viscosupplementation products and sometimes used to mean noncrosslinked hyaluronan, as opposed to crosslinked higher molecular weight hyaluronan hta, health technology assessment. Viscosupplementation agents are preparations that have hyaluronic acid, which is injected. Of those who are, many report feeling some pain relief during the 3 to 5week course of the injections, while pain relief is delayed in others. Increased cartilage volume was observed by means of imaging examinations. Pdf viscosupplementation for osteoarthritis of the knee. Viscosupplementation is a treatment for chronic moderate symptomatic oa, and not for flares with joint swelling. To our knowledge, this is the largest series of patients with hip osteoarthritis treated with viscosupplementation. Intraarticular injections corticosteroids and hyaluronic acid. The structural benefit of viscosupplementation has been seen through secondlook arthroscopy, performed one year after treatment started, in which the joint surface was seen to have a better visual appearance, compared with a placebo group.
R2, r3, r4, r5, r6 what is the role of viscosupplementation for treating osteoarthritis of the knee. Viscosupplementation or hyaluronic acid or adant or amvisc or arthrease or. Normally, pain relievers such as ibuprofen or nonsteroidal antiinflammatory drugs nsaids are used, along with physical therapy, applications of a topical analgesic and injections of a corticosteroid. Osteoarthritis oa is a disabling disease that produces severe morbidity reducing physical activity. Viscosupplementation in patients with hemophilic arthropathy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Pdf ua\r aetna\r accessible pdf \r medication request form\r medication request, specialty medication request, viscosupplementation\r medication request, durolane, euflexxa, gelone, gelsyn, genvisc, hyalgan, hymovis, monovisc, orthovisc, supartz, syn\ visc, synviscone created date. If you have tried all other nonsurgical treatment methods and your pain continues to limit your activities, viscosupplementation may be an option. These tools are suggested to minimize the need for higher risk treatments such as nonsteroidal antiinflammatory drugs nsaids and surgery. A 67yearold woman with osteoarthritis of the right knee seeks guidance regarding the possible benefit of hyaluronate injection. Comparative assessment of viscosupplementation with polynucleotides and hyaluronic acid pnha1401. Final evidence report page iii key abbreviations acronyms ha, hyaluronic acid sometimes used to refer to all viscosupplementation products and sometimes used to mean noncrosslinked hyaluronan, as opposed to crosslinked higher. Synvisc and synviscone new york state department of health. Intraarticular injections of hyaluronan inj033 billing.
The physicians want to report 20610 to the payor for the injection and have the patient self pay for the. In this procedure, a gellike fluid called hyaluronic acid is injected into the knee joint. Viscosupplementation market by product type, application. For patients with osteoarthritis of the knee, the addition of manual physical therapy. Viscosupplementation therapy for knee cpt code 20610. Intraarticular injections in joints other than the knee and for indications outside of osteoarthritis of. Amssm scientific statement concerning viscosupplementation. Hyaluronans, viscosupplementation for osteoarthritis of the knee.
Intraarticular hyaluronan injections are not recommended for the treatment of oa of the knee, or any other joint. Comparison of two different molecular weight intraarticular injections of hyaluronic acid for the treatment of knee osteoarthritis. Listing a study does not mean it has been evaluated by the u. How soon after viscosupplementation injections do patients report pain relief. There is a lot of confusion in our office when the doctor injects viscosupplementation and it is not covered by a plan. What is the evidence for hyaluronic acid intraarticular injections. Another treatment option is viscosupplementation with intraarticular injection of hyaluronan ha. For this procedure, the doctor will inject hyaluronic acid directly into the affected joint. The american college of rheumatology supports patient access to appropriate therapies including hyaluronic acid injection. Viscosupplementation treatment for knee arthritis orthoinfo. Viscosupplementation for osteoarthritis notice this policy contains information which is clinical in nature. Herc coverage guidance viscosupplementation for oregon. The benefits of viscosupplementation injections are not immediate.
Osteoarthritis oa is the most common form of arthritis. Viscosupplementation market by product type single injection, three injections, and five injections, application knee osteoarthritis, hip osteoarthritis, and hand osteoarthritis, source animal and nonanimal, distribution channel retail pharmacies, hospital pharmacies, and online pharmacies, geography and forecast. Viscosupplementation market by product type, application and. Soft tissue and joint injections 37 trigger point injections 37 prolotherapy also known as sclerotherapy.
Dec 06, 2015 the clinical results from viscosupplementation are important and its benefit has now been well established. Amssm scientific statement concerning viscosupplementation injections for knee. Definition viscosupplementation is a treatment procedure recommended in patients who are suffering from degenerative conditions such as osteoarthritis. Viscosupplementation for osteoarthritis of the knee nejm. As we communicated previously, we changed our medical coverage guidelines on april 1, 2015, for intraarticular hyaluronan drugs, commonly called viscosupplements, for members under 65 years of age. Member has tried and experienced an intolerable adverse event to hyalgan, hymovis, and synvisc or synvisc. Mar 20, 2017 here at direct orthopedic care doc, many patients come to us as an attempt to avoid surgical intervention. Viscosupplement injections not covered important reminder. Some patients may experience benefit with 3 injections given at weekly intervals. The physicians want to report 20610 to the payor for the injection and have the patient self pay for the drug. Viscosupplementation information what is viscosupplementation.
This means we will deny authorization requests for viscosupplement drugs as not. Background the injection of hyaluronic acid often termed viscosupplementation or ha injection was introduced in europe in the 1980s as a therapeutic option for patients with knee pain due to osteoarthritis. Joints affected by osteoarthritis have less hyaluronic acid, which is naturally present in the synovial fluid. Viscosupplementation definition of viscosupplementation. Evidence supports the use of intraarticular hyaluronan or hylan injections for oa of the knee. Hyaluronic acid is a type of viscous carbohydrate called a glycosaminoglycan, and ultimately a major component of the mechanism involving the natural protection and. Intraarticular injections in joints other than the knee and for indications outside of osteoarthritis of the knee are considered investigational. Marketing history synviscone has not been marketed in any country to date. What are hyaluronic acid viscosupplementation injections. Compare prices and find information about viscosupplements prescription drugs. In order for joints to move smoothly, they must contain an adequate amount of cartilage and synovial fluid. Hyaluronate injections for osteoarthritis of the knee emblemhealth.
This treatment has been called viscosupplementation. Apr 15, 2015 comparative assessment of viscosupplementation with polynucleotides and hyaluronic acid pnha1401 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Oa is a common problem and is often referred to as degenerative joint disease. New york knee injury medical treatment guidelines third edition, september 15, 2014. When the injections are administered bilaterally, list j7321, j7323 or j7324 in item 24 fao09 electronically with a 2 in the units field. But first, it is important to understand the mechanics of the knee and arthritis. An overview of viscosupplementation for the treatment of knee arthritis. Viscosupplementation for knee osteoarthritis cleveland clinic. Viscosupplementation is done as an outpatient procedure, and the application method has only been well established for knees.
Hyaluronic acid is a polysaccharide consisting of repeating molecules of. Viscosupplementation side effects, cost and definition. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Our position statement on treatment of knee oa with viscosupplementation injection hyaluronic acid, ha versus steroid intraarticular corticosteroids, ias and placebo intraarticular placebo, iap is based on the evaluation of treatment effect by examining the number of participants. Medicare will consider viscosupplementation therapy for the knee via intraarticular injections of hyaluronic preparations medically reasonable and necessary when all of the following conditions are met. Synviscone has not been withdrawn from marketing in any countries. To date, the ideal patient for viscosupplementation has yet to be defined. To prevent pain and swelling, your doctor may recommend resting your knee or applying ice for a short time after. Viscosupplementation using intraarticular injections of hyaluronan synvisc one is a relatively new treatment. Intraarticular viscosupplementation for treatment of osteoarthritis of. Ultrasound guidance, fluoroscopic guidance and knee arthrography for viscosupplement injections is noncovered. One of the common treatments our providers will suggest before recommending surgery to a patient is viscosupplementation.
Because the injections are given over time, you may begin to feel. Here at direct orthopedic care doc, many patients come to us as an attempt to avoid surgical intervention. Among the treatment methods, viscosupplementation intraarticular injection of hyaluronic acid derivatives has been gaining more. Injections the first line of treatment for osteoarthritis of the knee aims to relieve pain. Intraarticular viscosupplementation with hylan gf 20 to treat. Three to five injections, each 1 week apart, are required. Synvisc and synviscone hyaluronic acid is a naturally occurring substance within the synovial fluid of a joint that acts as a shock absorber, lubricant, and antiinflammatory agent. Injection of subcutaneous lidocaine or similar local anesthetic may be recommended prior to injection of supartz fx. The best results from viscosupplementation occur between the fifth and thirteenth weeks. Osteoarthritis of the knee has become epidemic in the united states due to high athletic regence and aetna coverage policies for viscosupplementation.
Hyaluronic acid ha is a naturally occurring substance found the human body. Viscosupplementation is an intraarticular injection of hyaluronic acid into the knee joint by an physician. Synvisc and synviscone evidence is also available in portable document format pdf. Another treatment option is a procedure called viscosupplementation. Fda summary of safety and effectiveness data page 2 trivisc is a sterile, viscoelastic, nonpyrogenic solution of purified, high molecular.
Viscosupplementation therapy for knee cpt code 20610, j7321, j7327 and covered dx medicare will consider viscosupplementation therapy for the knee via intraarticular injections of hyaluronic preparations medically reasonable and necessary when all of the following conditions are met. Typically covered by insurance, this procedure can oftentimes help patients avoid knee replacement surgery. The efficacy of viscosupplementation is a matter of ongoing debate, after discordant findings in some metaanalyses. The synvisc brand of hylan gf 20 is usually given once every week until you have received 3 injections. Amssm scientific statement concerning viscosupplementation i. Corticosteroid injection prior to hip or knee arthroplasty. This advice will help to inform government decisions about which.
Zhang 2008 oarsi injections of intraarticular hyaluronate may be useful in patients with knee oa. Evidence is also available in portable document format pdf. Viscosupplementation for knee osteoarthritis cadth. Viscosupplementation agents are preparations that have hyaluronic acid, which is injected into the knee joint to relieve pain associated with osteoarthritis. Pdf ua\r\naetna\r\naccessible pdf \r\nmedication request form\r\nmedication request, specialty medication request, viscosupplementation\r\nmedication request, durolane, euflexxa, gelone, gelsyn, genvisc, hyalgan, hymovis, monovisc, orthovisc, supartz, syn\ visc, synviscone created date. Viscosupplementation injections are done in the office setting. Viscosupplementation injections des plaines degenerative. Orthopedics the injection of hyaluronan or derivativeshylans into joints to manage osteoathritis, improve synovial fluid elasticity and viscosity and relieve pain. It is known that the patients who suffer from osteoarthritis have reduced. When intra articular hyaluronan injections are not covered the use of intraarticular hyaluronan injections in the knee is not covered when the above criteria are not met. There are no guidelines regarding the optimal number of injections needed to obtain optimal clinical response, which seems to be different 1, 2, 8, 10, 11 between products and dependent on the molecular weight mw. Hyaluronan injections overrides non approvable washington medicaid see state specific mandate below medications durolane sodium hyaluronate euflexxa sodium hyaluronate gelone crosslinked sodium hyaluronate gelsyn3 sodium hyaluronate genvisc 850 sodium hyaluronate hyalgan sodium hyaluronate, all dose forms. Viscosupplementation using other brands j7320j7324, j7326j7328 for osteoarthritis of the knee is noncovered for advantage and elite.
Injections of hyaluronate for viscosupplementation have been used i. Knee joints are composed of bone on either side of the joint, cartilage on both sides of the bone, and a single unit of free floating cartilage between. Some poor results may be due to inappropriate use of ha injections, poorly adapted to the patients oa phenotype. Vadod clinical practice guideline for osteoarthritis. The area of injection is first cleansed and any excess joint fluid is removed with a syringe. Comparative assessment of viscosupplementation with. Viscosupplementation for knee pain vitality medical centers. This has been noted in a study in which patients with 3 injections were followed for 90 days. Viscosupplementation should be limited to patients who are. Gigis i, fotiadis e, nenopoulos a, tsitas k, hatzokos i. Your doctor will determine how many injections you should receive. Comparative assessment of viscosupplementation with polynucleotides and hyaluronic acid to viscosupplementation with hyaluronic acid in the treatment of osteoarthritis of the knee. Viscosupplementation therapy for knee cpt code 20610, j7321, j7327 and covered dx.