Hyaluronic Acid Intra-articular Products

Covered: FDA‑approved hyaluronic acid intra‑articular products for osteoarthritis of the knee only (other joints are not covered). Key requirements: initial approval requires radiologic confirmation of knee OA, at least one course of physical therapy, trials of ≥2 pharmacologic therapies (NSAID, acetaminophen, tramadol, or duloxetine), ≥2 intra‑articular corticosteroid injections, administration/supervision by a rheumatology/orthopedic/PM&R specialist and adherence to product‑specific dosing for a 6‑month approval; reauthorization requires ≥6 months since last HA injection and documented prior clinical benefit.

"When requesting hyaluronic acid intra-articular products, the individual requiring treatment must be diagnosed with the following FDA-approved indication and meet the specific coverage guidelines a..."

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