Viscosupplements (Revised)

By January 1, 2026 (retroactively effective): Billing team must implement prior authorization workflow for all viscosupplement claims on Humana Medicaid Ohio. (1) Update billing system to flag all viscosupplement intra-articular claims (Durolane, Euflexxa, Gel-One, Gelsyn-3, GenVisc 850, Hyalgan, Hymovis, Hymovis-ONE, Monovisc, Orthovisc, Supartz FX, SynoJoynt, Synvisc, Synvisc-One, Triluron, TriVisc, Visco-3) as requiring prior authorization before submission. (2) Provide providers with clinical criteria checklist requiring documentation of: symptomatic knee OA (knee-only), prior treatment/contraindication/intolerance with TWO of the four first-line products (Durolane, Euflexxa, Gelsyn-3, Supartz FX) for requested second-line products, and 6-month interval since last treatment cycle for re-treatments. (3) Update encounter forms and EMR templates to capture these required data elements. (4) Front desk staff and billing team must verify prior authorization approval BEFORE processing claims. (5) Refer to Humana PAL portal (www.humana.com/PAL) for current medical and procedural billing codes. NOTE: Policy document does not specify explicit CPT/HCPCS codes; contact Humana PAL directly to identify applicable injection and administration codes. Claims submitted without prior authorization or missing required clinical documentation will be denied.