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MedicaidPrior AuthHigh impact

Viscosupplements (Revised)

Humana·IN · Orthopedics, Pain Management, Sports Medicine +1 more·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 25, 2026
Days to comply

Summary

This revised Humana Medicaid-Indiana viscosupplement policy (effective July 1, 2024, revised March 1, 2026) establishes prior authorization requirements for 18 hyaluronic acid injection products used to treat knee osteoarthritis. The policy requires documented symptomatic knee OA, previous treatment/contraindication/intolerance with two specific products (Durolane, Euflexxa, Gelsyn-3, or Supartz FX) for certain alternatives, and a 6-month interval between treatment cycles for re-treatment requests.

Action Required

Action needed
By March 1, 2026 (revision date): Billing team must implement prior authorization requirements for all viscosupplement claims under Humana Medicaid-Indiana. (1) Update billing system to flag all claims for Durolane, Euflexxa, Gel-One, Gelsyn-3, GenVisc 850, Hyalgan, Hymovis, Hymovis-ONE, Monovisc, Orthovisc, Supartz FX, SynoJoynt, Synvisc, Synvisc-One, Triluron, TriVisc, and Visco-3 as requiring prior authorization. (2) Ensure prior auth requests include documented evidence of symptomatic knee osteoarthritis limited to the knee joint. (3) For patients requesting Gel-One, GenVisc 850, Hyalgan, Hymovis, Hymovis-ONE, Monovisc, Orthovisc, SynoJoynt, Synvisc, Synvisc-One, Triluron, TriVisc, or Visco-3, verify documentation of previous treatment failure, contraindication, or intolerance with at least TWO of the following: Durolane, Euflexxa, Gelsyn-3, or Supartz FX before submission. (4) For re-treatment requests, confirm at least 6 months have elapsed since the last treatment cycle and include this verification in the prior auth request. (5) Add patient allergy screening questions to encounter forms to identify known allergies to poultry/eggs/feathers (avian-derived products marked with *) and bacterial proteins (bacterial-derived products marked with ∞). (6) Train providers and front-desk staff on documentation requirements. Failure to obtain prior authorization or submit incomplete documentation will result in claim denials.