Does J7326 require prior authorization?

Yes, J7326 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J7326?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J7326`, Hyaluronan or derivative, gel-one, for intra-articular injection, per dose

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The medical record must document relevant medical history, physical examination, pertinent diagnostic test/procedure results, and history of pharmacologic therapy supporting medical necessity.
Documentation for subsequent courses must clearly establish reduction in patient symptomatology and medication usage and must be available upon request.

Key Coverage Criteria

Intra-articular hyaluronan injections are covered for pain associated with osteoarthritis of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and simple analgesics.
Intra-articular hyaluronan injections may be used as a therapeutic option for osteoarthritis of the shoulder.
Intraarticular hyaluronan is covered for treatment of symptomatic osteoarthritis of the knee in patients who have failed to respond adequately for at least 3 months to simple analgesics and conservative nonpharmacologic therapy (exercise/physical therapy, weight loss if appropriate, use of assistive devices).
Repeat courses are covered when the prior series produced documented significant improvement in knee pain and functional capacity and at least 6 months have elapsed since the last injection series for that knee.
Viscosupplementation is covered only when furnished and administered by a physician or appropriately trained provider in an appropriate clinical setting and when the drug is not usually self-administered by the patient (incident-to rules may apply).
Intra-articular hyaluronic acid (viscosupplementation) injections are billable for treatment of knee osteoarthritis only when the service meets the Local Coverage Determination L39260 clinical criteria and the product is used consistent with FDA‑approved dosing and frequency.

16 Active Policies

WPS-J5-L39529, Intraarticular Knee Injections of Hyaluronan

A56157, Billing and Coding: Intraarticular Knee Injections of Hyaluronan

NGS-J6-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

A52420, Billing and Coding: Hyaluronans Intra-articular Injections of

WPS-J8-L39529, Intraarticular Knee Injections of Hyaluronan

PALMETTO-JJ-L39260, Hyaluronic Acid Injections for Knee Osteoarthritis

NGS-JK-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

PALMETTO-JM-L39260, Hyaluronic Acid Injections for Knee Osteoarthritis

MODA-HYALURONICACIDDERIVATIVES-D535986256, Hyaluronic Acid Derivatives: Durolane, Euflexxa, Gel-One, GelSyn-3, GenVisc 850, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz/Supartz FX, Synojoynt, Synvisc, Synvisc-One, Triluron, TriVisc, VISCO-3, & sodium hyaluronate 1%

AETNA-CPB-0179, Viscosupplementation

UMR-POL-UMR-sodium-hyaluronate, Sodium Hyaluronate

SUREST-POL-SUREST-sodium-hyaluronate, Sodium Hyaluronate

UHCMA-POL-UHC_MA-treatment-tmj-joint, Treatment of Temporomandibular Joint (TMJ)

BCBSTN-a8a59bbb3c, Hyaluronic Acid Derivatives: Durolane, Euflexxa, Gel-One, GelSyn-3, GenVisc 850, Hyalgan, Hymovis, Hymovis One, Monovisc, Orthovisc, Supartz FX, Synojoynt, Synvisc, & Synvisc-One, Triluron, TriVisc, VISCO-3

A59030, Billing and Coding: Hyaluronic Acid Injections for Knee Osteoarthritis

UHC-POL-sodium-hyaluronate, Sodium Hyaluronate

`J7326`, Hyaluronan or derivative, gel-one, for intra-articular injection, per dose

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

J7326, Hyaluronan or derivative, gel-one, for intra-articular injection, per dose

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

`J7326`, Hyaluronan or derivative, gel-one, for intra-articular injection, per dose