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Intra-articular Hyaluronan Injections for Osteoarthritis
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Durolane and Euflexxa may be considered medically necessary for painful osteoarthritis of the knee in patients who have insufficient pain relief from conservative nonpharmacologic therapy and simple analgesics. Repeated courses of these two products may be considered medically necessary only when the prior course gave significant pain relief and at least six months have passed since the prior course in the affected knee, and intra-articular hyaluronan injections into joints other than the knee are considered investigational. The other listed hyaluronan products are not covered on any BCBSMS Formulary.
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What to do
Action · 5 steps
01Already effective 01/01/2025: HCPCS codes J7320, J7321, J7322, J7324, J7325, J7326, J7327, J7328, J7329, J7331 and J7332 were moved from the covered codes table to the Not Covered/Non-Formulary table.
02Billing team: The covered codes in the source are HCPCS J7318 (Durolane, 1 mg) and J7323 (Euflexxa, per dose), with CPT 20610 (without ultrasound guidance) or 20611 (with ultrasound guidance, with permanent recording and reporting) for the arthrocentesis or injection.
03The covered diagnoses are ICD-10 M17.0 through M17.12, M17.2 through M17.5 and M17.9.
04Services related to delivery or administration of a medication determined not medically necessary are also considered not medically necessary, and services related to a self-administered drug are not covered.
05State Health Plan participants: Perform a formulary drug search with the plan's Pharmacy Benefit Manager and submit any required Prior Authorization Requests to the Plan's Pharmacy Benefit Manager.
Codes mentioned
2061020611J7318J7323J7320J7321J7322J7324J7325J7326J7327J7328J7329J7331J7332M17.0M17.9
Original notice
Intra-articular Hyaluronan Injections for Osteoarthritis
bcbsms.com · Always check the source before changing claims.
Related changes
See all Blue Cross & Blue Shield of Mississippi changes →State and School Employees' Health Insurance Plan - Intra-articular Hyaluronan Injections for OsteoarthritisHighEffective Jan 1, 2025 · Medical PolicyTrigger Point InjectionsMediumNo effective date · Medical PolicyContinuous Passive Motion in the Home SettingMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list