Viscosupplementation for Osteoarthritis

Viscosupplementation by intra‑articular injection (single or multi‑injection series) with U.S. FDA‑approved hyaluronan preparations is covered for symptomatic, functionally limiting osteoarthritis of the knee when documented diagnostic criteria are met (e.g., ≥6 months of symptoms with clinical signs and/or imaging confirmation such as osteophytes). Coverage is limited to FDA‑approved knee hyaluronan products, requires failure of a comprehensive conservative program (including pharmacologic therapy, physical therapy, exercise, orthotics, joint aspiration and at least one intra‑articular steroid) and adherence to member benefit/contract rules; repeat treatment is allowed only after ≥6 months if prior cycles provided meaningful improvement.

"Therapy is covered when proven effective for the relevant diagnosis or procedure based on current peer‑reviewed scientific literature."