There are a number of carriers that will not cover Viscosupplementation for the treatment of osteoarthritis in the knee, as they deem it ineffective. Specific carrier verbage reads:

"….. many analyses have not shown a clinical benefit beyond the effect seen with placebo, and evidence from recent large, double-blinded, and high-quality trials suggests the clinical benefit of hyaluronan is of minimal benefit over intra-articular placebo (Bannuru, 2015).

The question raised is are providers still allowed to bill the injection (20610, 20611) for OA to the carrier, and charge the patient for the drug? Or because we are injecting a substance that is not covered by the plan, would the administration of that substance also fall under not medically necessary?

Here is the actual policy from the carrier for your reference. https://www.empireblue.com/medicalpo…pw_c160709.htm

Thank you for your help.