CurrentAnthemPolicy N/A

Medicare Part B intra-articular hyaluronic acid products — Voluntary Steerage

Defines inclusion of specific Medicare Part B hyaluronic acid (viscosupplement) J-codes in Anthem's Voluntary Steerage program for dates of service beginning January 1, 2019; affects providers requesting precertification for these devices under Anthem Medicare Part B products.

Policy Summary

PayerAnthem

PolicyMedicare Part B intra-articular hyaluronic acid products — Voluntary Steerage

Policy CodePolicy N/A

Change TypeInformational — administrative program inclusion

Effective DateJan 1, 2019

Next Review DateN/A

Key ActionObtain precertification and identify the specific hyaluronic acid J-code requested; nonpreferred devices may be steered to preferred products or denied under the Voluntary Steerage program.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

>=11listed hyaluronic acid device J-codes referenced

2019-01-01effective date for inclusion

Coverage Criteria

This document does not establish clinical inclusion or exclusion criteria for intra‑articular hyaluronic acid (viscosupplementation) use. It is administrative in nature and identifies device status (preferred versus nonpreferred) for Anthem’s Voluntary Steerage program rather than defining medical necessity or patient‑level treatment criteria.

HCPCS / J-code Listing

Medicare Part B hyaluronic acid J-codes (preferred and nonpreferred)HCPCS

J7323	Euflexxa
J7321	Hyalgane/Supartz
J7318	Durolane
J7326	Gel-One (Nonpreferred)
J7328	Gelsyn-3 (Nonpreferred)
J7320	Genvisc 850
J7322	Hymovis
J7327	Orthovisc
J7324	Orthovisce
J7325	Synvisc or Synvisc-One

1–10 of 11

1/2

Provider Actions and Prior Authorization

Prior Authorization

Prior Authorization Required

Precertification is required for specified Medicare Part B hyaluronic acid device J-codes. When requesting precertification (initial or renewal), providers must identify the exact J-code for the hyaluronic acid product being requested. Failure to specify the exact J-code may delay processing or trigger Voluntary Steerage actions.

Policy Summary

PayerAnthem

PolicyMedicare Part B intra-articular hyaluronic acid products — Voluntary Steerage

Policy CodePolicy N/A

Change TypeInformational — administrative program inclusion

Effective DateJan 1, 2019

Next Review DateN/A

Key ActionObtain precertification and identify the specific hyaluronic acid J-code requested; nonpreferred devices may be steered to preferred products or denied under the Voluntary Steerage program.

SourceLink

On This Page

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Required: specify exact J-code on precertification (initial or renewal).
Affected codes include Medicare Part B hyaluronic acid device J-codes (see Voluntary Steerage list).

Step Therapy

Voluntary Steerage to Preferred Products

Anthem operates a Voluntary Steerage program directing requests toward preferred hyaluronic acid devices to support cost-effective benefits. During precertification initiation or renewal, if a provider requests a nonpreferred device, the request may be subject to Voluntary Steerage processing which can include outreach to discuss preferred alternatives and potential substitution options.

Voluntary Steerage applies to Medicare Part B hyaluronic acid devices effective 2019-01-01.
Preferred devices include: Euflexxa (J7323); Hyalgane/Supartz (J7321); Durolane (J7318); Orthovisc (J7324); Synvisc/Synvisc-One (J7325); and others listed by the program.
Nonpreferred devices that may trigger steerage actions include: Gel-One (J7326); Gelsyn-3 (J7328); Genvisc 850 (J7320); Hymovis (J7322); Monovisc (J7327); Trivisc (J7329).

Denial Risk

Nonpreferred Device — Potential Steerage Actions

Requesting a nonpreferred hyaluronic acid device on the precertification form may prompt Voluntary Steerage processing. Providers should be prepared to document medical necessity for a nonpreferred product if they choose not to accept a preferred alternative.

If nonpreferred device is requested, precertification may include outreach or recommendations for preferred products.
Document clinical rationale if a nonpreferred device is medically necessary to avoid substitution.

Definitions

inv-08: Voluntary Steerage program

Program nameVoluntary Steerage program

PurposeAn administrative program to support cost-effective benefits by steering precertification requests toward preferred Medicare Part B devices.

Effective date for inclusionJanuary 1, 2019

ScopeApplies to specified Medicare Part B intra-articular hyaluronic acid (viscosupplementation) device J-codes during precertification initiation or renewal.

Provider impactProviders requesting a nonpreferred device during precertification (initiation or renewal) will be subject to the Voluntary Steerage process, which may lead to denial or steerage to preferred products.

Background

The document lists Medicare Part B intra‑articular hyaluronic acid products by their HCPCS / J‑codes and identifies which products will be managed under the Voluntary Steerage program effective for dates of service beginning January 1, 2019. During precertification initiation or renewal, providers requesting a nonpreferred device (as listed by J‑code) will be subject to the Voluntary Steerage process. Examples in the list include Euflexxa (J7323), Hyalgane/Supartz (J7321), Durolane (J7318) and identified nonpreferred products such as Gel‑One (J7326), Gelsyn‑3 (J7328), and others shown with their corresponding J‑codes.