Does Medicare Pay for Knee Gel Injections?

Your knees and ankles take a huge beating over the years. Most of your body weight rests on the strength of your knees. If you experience a knee injury or have a high BMI, you might have to get a knee replacement. Fortunately, knee gel injections offer a less invasive alternative treatment. But what do these shots do? Are there different types of knee injections? And does Medicare pay for knee injections?

What are Knee Injections and How Do They Help With Pain?

A knee injection is a shot that helps relieve joint pain and inflammation. Knee replacement surgery is costly, carries a long recovery time, and comes with the risk of infection or blood clots. On the other hand, injections are very safe, inexpensive, and require little or no time to recover. Your doctor gives you a shot, and that’s pretty much it!

So, how do knee gel shots work? When your doctor gives you the shot, it sends anti-inflammatory fluid into the joint. This fluid helps lubricate the knee joint and allows for pain-free movement. It also replaces lost cartilage that cushions your bones. Doctors most often prescribe these injections (also known as injections of hyaluronic acid) for chronic knee pain due to osteoarthritis.

The effects of these shots last for up to 6 months. During this time, you will have a broader range of movement with your knees. You will also have less knee pain during daily activities. However, these shots may have some adverse side effects like swelling or muscle stiffness. You will also feel some pain at the injection site.

Learn more: Does Medicare Cover Chiropractors?

Different Types of Knee Injections 

Gel shots are just one of many different types of knee injections. Here are a few of the most common types:

• Corticosteroid – These shots offer relief for people suffering from a wide range of conditions — from arthritis to IBS. When injected in the knee or other joints, Corticosteroid injections reduce pain and inflammation by preventing collagen production. These effects generally last for 2-3 months. A patient can only receive a limited number of these injections per year.
• Platelet-Rich Plasma (PRP) – PRP shots use a patient’s plasma to promote healing of the soft tissue and reduce inflammation. Doctors frequently use these injections to treat osteoarthritis, as they are low risk and have limited side effects.
• Placental Tissue Matrix (PTM) – Placental tissue is obtained after a mother gives birth to a baby. Injection of this tissue into the knee can treat long-term joint pain. However, PTM shots can vary in efficacy so that a doctor may prescribe them with another form of treatment. 
• Hyaluronic Acid Injections (HA) or Viscosupplementation – These are the technical terms for knee gel injections. As outlined above, a Hyaluronic Acid injection reduces pain and inflammation by mimicking the effects of natural joint fluid. They are best for patients with diabetes, as they do not raise blood sugar levels like Corticosteroid shots. Synvisc-One is one of the most commonly prescribed forms of HA treatment.

How Does Medicare Cover Knee Injection Treatment?

Medicare will cover knee injections once every six months if they are medically necessary. The injections are covered under Medicare Part B and subject to the annual Part B deductible. X-rays are required prior to Medicare approval.

As mentioned above, there are many different injection treatments for the knees. Let’s go down the list to see how Medicare treats different types of shots:

• Does Medicare cover Corticosteroid shots? Yes.
• Does Medicare cover PRP shots? No. Most health insurance plans don’t cover PRP shots.
• Does Medicare cover PTM shots? Yes.
• Does Medicare cover HA shots? Yes.

Is Synvisc One Covered by Medicare?

Doctors often prescribe Synvisc One to treat pain and osteoarthritis. Medicare coverage will foot the bill for Synvisc One, as it is a form of HA shot. Synvisc One has limited side effects, though you may experience some pain at the injection site.

How many Cortisone injections can I have in one knee?

Cortisone injections are used when your knee is experiencing pain. This is a anti-inflammatory drug that is injected in the knee joint. Even though this lessens stress on the knee, this is a short term solution to pain and it’s recommended that you only get this cortisone injection once ever three to four months. With a limit to four injections per knee. If you would like to learn more about how you can get these injections covered by a Medicare supplement, contact us at 800-208-4974 for more information.

What is Orthovisc for knee injections?

Orthovisc is a type of knee injection used to relieve pain due to osteoarthritis. This FDA-approved injection is given once a week for 3-4 consecutive weeks. The injections result with pain relief that lasts up to 6 months. However, side effects include: bruising, decreased appetite, diarrhea, headaches, and more.

Alternative Treatments for Knee Pain and Arthritis

In short, Medicare covers most kinds of knee injections for pain. Part B covers these shots as outpatient care. However, the shots must be medically necessary. This is important, as most doctors will try other forms of treatment before using injections. Some of these treatments include:

• Physical therapy
• Durable Medical Equipment (DME) like a walker or rollator
• Pain medication
• Heat and cold
• Weight loss

If these treatments prove ineffective, then your doctor will likely prescribe shots. Medicare will cover these injections once every six months for the duration of your treatment. The length of treatment will depend on the severity of your condition and the efficacy of your treatment.

Additional Coverage for Knee Treatment and Therapy

While Original Medicare will provide coverage for knee replacement surgery and gel injections, it may not cover other treatments. For example, if you need prescription drugs to manage your pain, you’ll need to get extra coverage. You could get drug coverage with a Part D or Medicare Advantage Prescription Drug plan (MAPD). 

That said, Original Medicare will cover most knee therapies. Medicare Part A covers inpatient surgeries, while Medicare Part B covers outpatient physical therapy. Part B also covers doctor’s visits and Durable Medical Equipment (DME).

How can a Medicare Supplement plan help?

While a Medicare Advantage plan may cover most of the costs, you may want to consider a Medicare Supplement plan. Medicare Supplement (also known as Medigap) helps cover costs that Original Medicare doesn’t cover. More specifically, a Medigap plan will allow you to see ANY doctor, anywhere in the country that accepts Original Medicare. 

For example, if you need gel shots once every six months, you might not meet your deductible in time. A Medigap plan can help pay your deductible, ensuring that Part B covers the injections. This could also save you money on other knee treatments covered by Medicare.

Read More: https://www.bluewaveinsurance.com/medicare-faqs/does-medicare-pay-for-knee-gel-injections/