Medicare AdvantagePrior AuthMedium impact
Viscosupplements - Multi Injection (Revised)
Humana·Orthopedics, Rheumatology, Sports Medicine·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its viscosupplement prior authorization policy effective January 28, 2026 (revision date). The policy maintains existing criteria requiring documented symptomatic knee osteoarthritis, prior treatment/failure with Orthovisc or Supartz FX (or continuation within 365 days for Part B), and 6-month intervals between retreatment cycles. No substantive coverage changes were made, but the policy was formally reviewed and re-issued, requiring billing teams to verify this is the current version in use.
Action Required
By January 28, 2026: Billing team must verify this revised policy version (dated 1/28/2026) is loaded in the prior authorization system and replace any older versions. Do NOT rely on printed copies. Prior to submitting viscosupplement claims for Euflexxa, Gelsyn-3, GenVisc 850, Hyalgan, Hymovis, SynoJoynt, Synvisc, Triluron, TriVisc, or Visco-3 on Medicare Advantage plans: (1) Confirm member has documented symptomatic knee osteoarthritis limited to knee only; (2) Verify prior treatment/contraindication/intolerance with Orthovisc OR Supartz FX (exception: if continuation within past 365 days for Part B, step therapy not required); (3) If retreatment, confirm at least 6 months elapsed since last cycle. Attach documentation supporting all three criteria to prior authorization requests. Update encounter forms and billing staff training materials with the revised January 28, 2026 policy version. Claims submitted without meeting all three criteria will be denied. Reference www.humana.com/PAL for provider claim codes.