Hyaluronic Acid Intra-articular Products

Hyaluronic acid intra‑articular injections are covered only for pain from radiologically confirmed knee osteoarthritis (not other joints) in patients who have failed conservative non‑pharmacologic therapy and analgesics. Coverage requires documentation of radiologic OA, trials of at least two of three modalities (≥1 course physical therapy; at least two of the listed pharmacologic therapies — note two or more NSAIDs count as one; and ≥2 intra‑articular corticosteroid injections), administration by or under a rheumatologist/orthopedic surgeon/physiatrist, adherence to product‑specific dosing, and reauthorization only after ≥6 months with documented prior clinical benefit (approvals limited to 6 months).

"Approval duration (initial and renewal) limited to 6 months."

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