Viscosupplementation is an intraarticular injection of hyaluronic acid into the knee joint by an physician. 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. Hyaluronic acid also known as hyaluron and hyaluronate is a natural substance normally found in the synovial fluid of our joints. Evidence supports the use of intraarticular hyaluronan or hylan injections for oa of the knee. This treatment has been called viscosupplementation.
Here at direct orthopedic care doc, many patients come to us as an attempt to avoid surgical intervention. Viscosupplementation therapy for knee cpt code 20610, j7321. Viscosupplementation agents are preparations that have hyaluronic acid, which is injected. Viscosupplementation for the treatment of knee arthritis. This means we will deny authorization requests for viscosupplement drugs as not. Viscosupplementation therapy for knee cpt code 20610. Synviscone has not been withdrawn from marketing in any countries. 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. 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. Definition viscosupplementation is a treatment procedure recommended in patients who are suffering from degenerative conditions such as osteoarthritis. Viscosupplementation injections are done in the office setting. The synvisc brand of hylan gf 20 is usually given once every week until you have received 3 injections. Viscosupplementation is done as an outpatient procedure, and the application method has only been well established for knees. Amssm scientific statement concerning viscosupplementation i.
Viscosupplementation using other brands j7320j7324, j7326j7328 for osteoarthritis of the knee is noncovered for advantage and elite. How soon after viscosupplementation injections do patients report pain relief. Gigis i, fotiadis e, nenopoulos a, tsitas k, hatzokos i. Increased cartilage volume was observed by means of imaging examinations. Because the injections are given over time, you may begin to feel. 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. Intraarticular viscosupplementation with hylan gf 20 to treat. 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.
Viscosupplementation agents are preparations that have hyaluronic acid, which is injected into the knee joint to relieve pain associated with osteoarthritis. Soft tissue and joint injections 37 trigger point injections 37 prolotherapy also known as sclerotherapy. Viscosupplementation for knee pain vitality medical centers. Intraarticular injections of hyaluronan inj 033 billing and coding guidelines. 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. There is a lot of confusion in our office when the doctor injects viscosupplementation and it is not covered by a plan. Three to five injections, each 1 week apart, are required. This has been noted in a study in which patients with 3 injections were followed for 90 days. Compare prices and find information about viscosupplements prescription drugs. These tools are suggested to minimize the need for higher risk treatments such as nonsteroidal antiinflammatory drugs nsaids and surgery. Herc coverage guidance viscosupplementation for oregon. Hyaluronic acid ha is a naturally occurring substance found the human body.
Viscosupplementation for osteoarthritis of the knee nejm. Viscosupplementation definition of viscosupplementation. Marketing history synviscone has not been marketed in any country to date. Viscosupplementation in patients with hemophilic arthropathy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Comparative assessment of viscosupplementation with polynucleotides and hyaluronic acid to viscosupplementation with hyaluronic acid in the treatment of osteoarthritis of the knee. What is the evidence for hyaluronic acid intraarticular injections. Fda summary of safety and effectiveness data page 2 trivisc is a sterile, viscoelastic, nonpyrogenic solution of purified, high molecular. Comparative assessment of viscosupplementation with. 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.
For patients with osteoarthritis of the knee, the addition of manual physical therapy. New york knee injury medical treatment guidelines third edition, september 15, 2014. For this procedure, the doctor will inject hyaluronic acid directly into the affected joint. Pdf viscosupplementation for osteoarthritis of the knee. Some poor results may be due to inappropriate use of ha injections, poorly adapted to the patients oa phenotype. Member has tried and experienced an intolerable adverse event to hyalgan, hymovis, and synvisc or synvisc. Some patients may experience benefit with 3 injections given at weekly intervals. 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. Intraarticular viscosupplementation for treatment of osteoarthritis of. Orthopedics the injection of hyaluronan or derivativeshylans into joints to manage osteoathritis, improve synovial fluid elasticity and viscosity and relieve pain. The great majority of studies have been on knees, but intraarticular injection of hyaluronic acid has also presented good results in hips, shoulders, ankles, elbows, hand and feet34, 35.
A 67yearold woman with osteoarthritis of the right knee seeks guidance regarding the possible benefit of hyaluronate injection. Injections the first line of treatment for osteoarthritis of the knee aims to relieve pain. Intraarticular injections of hyaluronan inj033 billing. Comparative assessment of viscosupplementation with polynucleotides and hyaluronic acid pnha1401. This advice will help to inform government decisions about which. When the injections are administered bilaterally, list j7321, j7323 or j7324 in item 24 fao09 electronically with a 2 in the units field.
Viscosupplementation side effects, cost and definition. Injections of hyaluronate for viscosupplementation have been used i. Hyaluronans, viscosupplementation for osteoarthritis of the knee. 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. Vadod clinical practice guideline for osteoarthritis. Hyaluronic acid is a type of viscous carbohydrate called a glycosaminoglycan, and ultimately a major component of the mechanism involving the natural protection and.
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. Another treatment option is a procedure called viscosupplementation. To our knowledge, this is the largest series of patients with hip osteoarthritis treated with viscosupplementation. Hcpcs code j7321, j7323, and j7324 are per dose codes. To date, the ideal patient for viscosupplementation has yet to be defined.
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. Your doctor will determine how many injections you should receive. Viscosupplementation for knee osteoarthritis cleveland clinic. Intraarticular injections in joints other than the knee and for indications outside of osteoarthritis of. Mar 20, 2017 here at direct orthopedic care doc, many patients come to us as an attempt to avoid surgical intervention. But first, it is important to understand the mechanics of the knee and arthritis. 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. Synvisc and synviscone evidence is also available in portable document format pdf. Viscosupplementation using intraarticular injections of hyaluronan synvisc one is a relatively new treatment. To prevent pain and swelling, your doctor may recommend resting your knee or applying ice for a short time after. Joints affected by osteoarthritis have less hyaluronic acid, which is naturally present in the synovial fluid. 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. 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.
Osteoarthritis oa is a disabling disease that produces severe morbidity reducing physical activity. The physicians want to report 20610 to the payor for the injection and have the patient self pay for the. Viscosupplementation for osteoarthritis notice this policy contains information which is clinical in nature. 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. Viscosupplementation is a treatment for chronic moderate symptomatic oa, and not for flares with joint swelling. Intraarticular injections corticosteroids and hyaluronic acid. Hyaluronate injections for osteoarthritis of the knee emblemhealth. Listing a study does not mean it has been evaluated by the u. The best results from viscosupplementation occur between the fifth and thirteenth weeks. Viscosupplementation information what is viscosupplementation. Viscosupplementation market by product type, application. Osteoarthritis oa is the most common form of arthritis.
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. Hyaluronans, viscosupplementation for osteoarthritis of. 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. Viscosupplementation treatment for knee arthritis orthoinfo. The synvisc one brand of this medicine is given only once. Osteoarthritis of the knee has become epidemic in the united states due to high athletic regence and aetna coverage policies for viscosupplementation. Viscosupplementation should be limited to patients who are.
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. R2, r3, r4, r5, r6 what is the role of viscosupplementation for treating osteoarthritis of the knee. Ultrasound guidance, fluoroscopic guidance and knee arthrography for viscosupplement injections is noncovered. The physicians want to report 20610 to the payor for the injection and have the patient self pay for the drug. Synvisc and synviscone new york state department of health. Corticosteroid injection prior to hip or knee arthroplasty. The efficacy of viscosupplementation is a matter of ongoing debate, after discordant findings in some metaanalyses.
Viscosupplementation or hyaluronic acid or adant or amvisc or arthrease or. Intraarticular hyaluronan injections are not recommended for the treatment of oa of the knee, or any other joint. Evidence is also available in portable document format pdf. The american college of rheumatology supports patient access to appropriate therapies including hyaluronic acid injection. Another treatment option is viscosupplementation with intraarticular injection of hyaluronan ha. It is known that the patients who suffer from osteoarthritis have reduced. Oa is a common problem and is often referred to as degenerative joint disease. Viscosupplement injections not covered important reminder. Viscosupplementation market by product type, application and.
Genvisc 850 is only for injection into the knee, performed by a qualified. Dec 06, 2015 the clinical results from viscosupplementation are important and its benefit has now been well established. The area of injection is first cleansed and any excess joint fluid is removed with a syringe. What are hyaluronic acid viscosupplementation injections. Intraarticular injections in joints other than the knee and for indications outside of osteoarthritis of the knee are considered investigational. Viscosupplementation for knee osteoarthritis cadth. Viscosupplementation therapy for knee cpt code 20610, j7321, j7327 and covered dx. The injection is routinely given under the guidance of ultrasound to ensure that the. Among the treatment methods, viscosupplementation intraarticular injection of hyaluronic acid derivatives has been gaining more. The benefits of viscosupplementation injections are not immediate. In order for joints to move smoothly, they must contain an adequate amount of cartilage and synovial fluid. Amssm scientific statement concerning viscosupplementation. For patients with osteoarthritis of the knee, the addition of manual physical therapy as an adjunct to traditional.
Hyaluronic acid is a polysaccharide consisting of repeating molecules of. Zhang 2008 oarsi injections of intraarticular hyaluronate may be useful in patients with knee oa. Comparison of two different molecular weight intraarticular injections of hyaluronic acid for the treatment of knee osteoarthritis. One of the common treatments our providers will suggest before recommending surgery to a patient is viscosupplementation. 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. 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. Typically covered by insurance, this procedure can oftentimes help patients avoid knee replacement surgery. Amssm scientific statement concerning viscosupplementation injections for knee. Injection of subcutaneous lidocaine or similar local anesthetic may be recommended prior to injection of supartz fx.
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