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Independence Blue CrossCommercial · Administrative · Pharmacy · Orthopedics, Rheumatology, Pain Management +1 moreLow impact

08.01.47a, Triamcinolone Acetonide Extended-Release Injectable (Zilretta®)

Effective date
Not stated in the notice
Identified
Jun 19, 2026

Summary

Independence Blue Cross reissued Policy 08.01.47a on 04/01/2026 with no substantive changes to Zilretta (triamcinolone acetonide ER injectable) coverage. The policy continues to cover the medication for knee osteoarthritis under HCPCS code J3304 when specific medical necessity criteria are met, including prior conservative therapy and intra-articular steroid injection failure. Repeat administrations and off-label uses remain non-covered unless supported as accepted off-label indications.

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What to do

Action · 4 steps
01No immediate action required.
02This is a routine annual policy reissue with no changes to coverage criteria, billing codes, documentation requirements, or reimbursement.
03Billing team should verify that existing systems continue to enforce the seven medical necessity criteria for Zilretta claims (age ≥18, documented OA knee diagnosis, no prior Zilretta treatment, documented inadequate response to conservative therapy, documented NSAID/tramadol trial failure, documented prior intra-articular steroid injection failure, and dose ≤32 mg single injection).
04Continue denying repeat injections to the same knee and all off-label uses unless separately approved as accepted off-label indications per the Company's off-label drug policy.

Codes mentioned

J3304M17.0M17.10M17.11M17.12M17.2M17.30M17.31M17.32M17.4M17.5

Original notice

08.01.47a, Triamcinolone Acetonide Extended-Release Injectable (Zilretta®)
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

Related changes

See all Independence Blue Cross changes →
MA08.097a, Triamcinolone Acetonide ER Injectable (Zilretta®)LowEffective Apr 1, 2026 · PharmacyMA05.070, Apos® biomechanical shoe systemLowEffective Jan 1, 2024 · Pharmacy05.00.84, Apos® biomechanical shoe systemLowEffective Jan 1, 2024 · Pharmacy11.14.07y, Intra-Articular Injection of Hyaluronan for the Treatment of OsteoarthritisHighEffective Dec 1, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOrthopedicsRheumatologyPain ManagementPharmacyCode J3304Code M17.0Code M17.10Code M17.11Code M17.12Code M17.2Code M17.30Code M17.31Code M17.32Code M17.4Code M17.5

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