Key takeaways
- Original Medicare (parts A and B) covers knee gel injections as a treatment for knee osteoarthritis if a person meets certain criteria.
- These shots work by improving lubrication and cushioning in the joint.
- A person enrolled in Original Medicare (parts A and B) must pay the 2025 deductible of $257. After that, Part B will cover 80% of their expenses if they qualify for coverage.
Doctors administer knee gel injections to treat knee osteoarthritis, the most common form of arthritis. They are also known as hyaluronic acid injections, viscosupplementation, or rooster comb injections.
These shots work by improving lubrication and cushioning in the joint. Osteoarthritis often results in a breakdown of the natural joint fluid that helps the knee move smoothly and absorbs shocks. Hyaluronic acid, the main component in these injections, mimics the natural fluid in the joint.
This article discusses the conditions under which Medicare will cover knee gel injections and how much a person can expect to pay out-of-pocket for the treatment.
Original Medicare (parts A and B) covers knee gel injections as a treatment for knee osteoarthritis if a person meets the criteria showing they have:
- a medical diagnosis of symptomatic osteoarthritis of the knee
- medical imaging confirming the osteoarthritis diagnosis
- unsuccessfully tried at least three conservative treatment types, which may include pain medication, physical therapy, assistive devices, and more.
- unsuccessfully tried glucocorticoid injections or couldn’t try such injections due to another health condition
A person who has had knee gel injections before can receive an additional injection series if they:
- keep meeting the initial criteria
- experience a return of symptoms
- notice pain improvement after the initial series
- had the first injection series at least six months before a potential second series
Medicare Advantage
A person insured with a Medicare Advantage (Part C) plan instead of Original Medicare (parts A and B) will receive coverage through a plan managed by a private insurer.
Part C plans must cover at least as much as Medicare Part A and Part B, but may offer coverage for knee gel injections under additional circumstances
That said, Original Medicare may not cover everything related to receiving hyaluronic acid treatment for knee osteoarthritis. Limitations may include:
- doses that exceed the recommended amount
- repeat the treatment after six months
- whether there are infections or diseases in the injection site
- diagnoses that are not osteoarthritis
In addition, various brands of injections have distinct treatment protocols. Some knee gel shot brands are:
- Synvisc
- Hyalgan
- Orthovisc
- Monovisc
- Supartz
For Medicare to cover these injections, a person must adhere to the approved treatment schedule for the specific brand their doctor prescribes and ensure a minimum six-month interval between treatment sets.
A 2022 study on nonsurgical treatments for knee osteoarthritis revealed that knee gel injections were the priciest at around $1,019 per session.
That said, a person’s costs can differ depending on where they get their shots, whether their doctor requires an ultrasound to guide the injection, and whether the injection is needed in one knee or both.
A person enrolled in Original Medicare (parts A and B) must pay the 2025 deductible of $257. After that, Part B will cover 80% of their expenses if they qualify for coverage.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Those enrolled in a Medigap plan may be able to use their plan to cover some or all of their Part B premium or deductible costs.
For those enrolled in Part C, your expenses will depend on their specific plan. The plan might also require them to use healthcare providers within its network for coverage. Otherwise, they may need to pay for the shots out of pocket.
Hyaluronic acid injections, also known as knee gel injections, viscosupplementation, or rooster comb injections, can be an effective treatment for knee osteoarthritis.
Original Medicare will cover these injections if they are deemed medically necessary. Furthermore, Part C provides coverage under similar conditions and might cover these injections in other scenarios.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.