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Independence Blue CrossCommercial · Billing Codes · Pharmacy · Orthopedics, Rheumatology, General Practice +1 moreHigh impact

11.14.07y, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis

Effective date
Dec 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated policy 11.14.07y to version 11.14.07z effective 12/01/2025, removing four unspecified laterality ICD-10 diagnosis codes (M17.10, M17.30, M17.5, M17.9) and aligning coverage criteria with FDA labeling and Novitas LCD L35529 recommendations. Billing teams must stop using the removed diagnosis codes and ensure claims use only the specified laterality codes (M17.0, M17.11, M17.12, M17.2, M17.31, M17.32, M17.4) for hyaluronan intra-articular injections.

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What to do

Action · 5 steps
01By 12/01/2025: Billing team must immediately remove diagnosis codes M17.10, M17.30, M17.5, and M17.9 from all hyaluronan injection claim submissions in the billing system and EMR.
02Update all templates, superbills, and diagnosis code lists to remove these four unspecified laterality codes.
03Replace with only the allowed codes: M17.0 (bilateral primary OA), M17.11/M17.12 (unilateral primary OA—right/left), M17.2 (bilateral post-traumatic OA), M17.31/M17.32 (unilateral post-traumatic OA—right/left), or M17.4 (bilateral secondary OA).
04Train clinical and administrative staff on the change.
05Claims submitted with removed codes will be denied or require rebilling with compliant diagnosis codes.

Codes mentioned

M17.10M17.30M17.5M17.9M17.0M17.11M17.12M17.2M17.31M17.32M17.4J7318J7320J7321J7322J7323J7324J7325

Original notice

11.14.07y, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

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MA11.023l, Hyaluronan Therapies for Osteoarthritis of the KneeMediumEffective Dec 1, 2025 · Medical PolicyMA11.023m, Hyaluronan Therapies for Osteoarthritis of the KneeLowEffective Jan 2, 2026 · Medical PolicyMA05.070, Apos® biomechanical shoe systemLowEffective Jan 1, 2024 · PharmacyMA08.097a, Triamcinolone Acetonide ER Injectable (Zilretta®)LowEffective Apr 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOrthopedicsRheumatologyGeneral PracticeSports MedicineCode M17.10Code M17.30Code M17.5Code M17.9Code M17.0Code M17.11Code M17.12Code M17.2Code M17.31Code M17.32Code M17.4Code J7318Code J7320Code J7321Code J7322Code J7323Code J7324Code J7325

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