Tuesday, September 26, 2023

Does Medicare Cover Knee Injections

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Your Insurance May Or May Not Cover Hyaluronic Acid Injections

The FDA has approved hyaluronic acid injections for osteoarthritis of the knee onlynot for OA that affects any other joints.

In part because the AAOS does not recommend hyaluronic acid injections for knee OA, there’s a strong possibility your insurance company will not cover it. If not, it’s important to know the procedure can be quite expensive: A course of three injections of Synvisc, for example, can cost as much as $1,600.

Medicare will cover HA injections for the knee, but you’ll likely have to provide documentation or X-ray evidence to prove it’s needed first. Both Medicare and private insurance typically will approve hyaluronic acid injections no more often than every six months.

What Medicare Doesnt Cover

Original Medicare, Part A and Part B, doesnt generally cover the following services and supplies. This may not be a complete list.

Alternative medicine: In general, Medicare doesnt cover most alternative or holistic treatments, including acupuncture and chiropractor services .

Cosmetic surgery: Medicare wont cover cosmetic surgery, unless it is medically required because of an injury or to improve functionality of a deformed body part. If you are a breast cancer patient who had a mastectomy, Medicare will cover breast prostheses.

Routine dental care: Original Medicare doesnt cover most routine dental services and supplies. This includes dentures, oral exams, cleanings, extractions, fillings, and root canals. Medicare Part A might pay for certain dental services that you get while youre in a hospital.

Foot care: Medicare does not cover routine foot care , but Part B covers medically necessary podiatrist services to treat foot injuries or diseases.

Hearing care: Medicare wont cover routine hearing exams, hearing aids, and exams to get fitted for hearing aids. However, you may be covered if your doctor orders a diagnostic hearing exam to see if you need further treatment.

Homemaker services: Medicare wont cover homemaker services, such as cooking and cleaning. An exception is if the beneficiary is in hospice care, and the homemaker services are included in the care plan.

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In This Video Ross Hauser Md Explains How One Injection Of Prp Will Likely Not Work

A transcript summary is below the video

We will often get emails from people who had previous PRP therapy without the desired healing effects. We explain to these people that their treatment probably did not work because the single PRP injection did not resolve knee instability. The PRP may have tried to create a patch in the meniscus or cartilage to help with a bone-on-bone situation but the instability and the wear and tear grinding down the meniscus and cartilage remains.

When a person has a ligament injury or instability, the knee becomes hypermobile causing degenerative wear and tear on the meniscus and knee cartilage. In other words, the cells of the meniscus and cartilage are being crushed to death. When you inject PRP cells into the knee, without addressing the knee instability, the injected PRP cells will also be subjected to the crushing hypermobile action of the knee. The single injection PRP treatment will not work for many people. The knee instability needs to be addressed with comprehensive Prolotherapy around the joint. Prolotherapy is the companion injection of simple dextrose. This is explained in detail below.

Hyaluronic Acid Injections Are Not Recommended By Major Medical Organizations

Orthopedics: What Is It, and Does Medicare Cover It?

In 2019 the American College of Rheumatology and the Arthritis Foundation conditionally recommended against treating knee arthritis with intra-articular hyaluronic acid in guidelines for managing OA of the knee, hip, and hand.Similarly, the American Academy of Orthopedic Surgeons does not recommend HA injections for knee arthritis.

This is largely because while replacing lost hyaluronic acid may sound like an easy fix for OA, research has not found this to be the case. In studies comparing hyaluronic acid injections to a placebo , the hyaluronic acid has been no more effective than the saline.

Similarly, there is no definitive answer to whether hyaluronic acid injections are any more effective than corticosteroid injections or oral medications. This doesn’t necessarily mean you won’t be helped with this treatment, but based on studies it’s possible you won’t.

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Caring Medical Research Case Studies

Our research team has published research on patient outcomes and case studies using bone marrow aspirate. Here is a sample of those outcomes. Again, we must remind you that this treatment does not work for everyone. Unfortunately, if you are reading this article you are probably very attuned to medical treatments that do not work.

In the medical journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, our Caring Medical research team published our findings in seven patients. The patients who were treated for knee pain are featured below:

Patient case Knee pain: A 69-year-old man

A 69-year-old male came into our office with pain in both knees, with his right knee significantly more painful. Pain resulted in frequent sleep interruption and limitation of exercise.

The patient had received prolotherapy at another office in the previous two years but felt that the treatment has reached its maximum ability to heal.

The patient was diagnosed with osteoarthritis and received five bone marrow/dextrose treatments in each knee at two-month intervals.

  • Two months after the final treatment, the patient reported that he was completely free of pain or stiffness in both knees, had regained full range of motion, no longer suffered sleep interruption, and was no longer limited in exercise or daily life activities.

Patient case Knee pain A 56-year-old woman

The patient received bone marrow/dextrose treatments for six visits with 810 week intervals.

Hyaluronic Acid Injections Or Viscosupplementation For Knee Osteoarthritis

Much like cortisone, it is very likely that this knee injection treatment has been explained to you already by your orthopedist. It is a conservative care plan to help you try to manage along until you can get a knee surgery scheduled or you are trying to do everything you can to avoid the knee surgery.

Also like cortisone, you may have already had viscosupplementation and the effects and benefits have now worn off and you need to treat your knee differently. For some people, they may not even be reading this sentence because they have moved down the article to other treatments because this one is no longer an option for them.

What is Hyaluronic acid injections or Viscosupplementation?

The explanation that you may have been given is that hyaluronic acid injections will provide a gel-like cushion in your knee, getting between the shin and thigh bones to alleviate your bone-on-bone situation. The injections increase the volume of the protective synovial fluid in the knee.

  • The treatment is therefore referred to as Viscosupplementation because you are supplementing the viscosity or the thick, sticky, gel-like properties of the synovial fluid. Hyaluronic acid is naturally occurring in the synovial fluid of the knee.

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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 helps cover costs that Original Medicare doesnt 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.

Different Types Of Knee Injections

Knee Replacement Implants – What Do They Look Like And What Are My Options?

Here are a few of the most common types:

  • Corticosteroid When injected in the knee or other joints, Corticosteroid injections reduce pain and inflammation. 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 shots use a patients 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.
  • Hyaluronic Acid Injections 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. Gel-One is one of the most commonly prescribed forms of HA treatment.

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Is Prp Controversial Yes Is It Effective Also Yes

When it works. Below are many citations and references showing the effectiveness of PRP.

Lets start with the most recent research of the effectiveness of PRP for knee osteoarthritis.

  • While an October 2020 study in The Journal of International Medical Research still acknowledges that the clinical efficacy of platelet-rich plasma in the treatment of osteoarthritis remains controversial, their examination of five clinical trials including 320 patients found: intra-articular injection of PRP is an effective treatment for osteoarthritis that can reduce post-operative pain, improve locomotor function, and increase patient satisfaction.
  • This is a June 2020 study from the journal Clinical Rheumatology, Here researchers suggested that Intra-articular PRP injection provided better effects than other injections for osteoarthritis patients, especially in knee osteoarthritis patients, in terms of pain reduction and function improvement at short-term follow-up. .
  • In a study published in the American medical journal Arthroscopy, medical university researchers suggested that PRP injections were more effective in the treatment of knee osteoarthritis, in terms of pain relief and self-reported function improvement at three, six, and twelve months follow-up, compared with other injection treatments. We are going to show the comparative research below.

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Study : Two Groups Of Patients One Group Gets Prp The Other Group Gets Cortisone How Did This Comparison Work Out

In an October 2020 study also comparing PRP and corticosteroid, similar findings were recorded. PRP results were better over time and the lack of side-effects should be considered if debating between one treatment or the other.

  • In this study, the researchers found PRP had more significant values for improvement in comparison with corticosteroids, especially in the long-term .
  • Both PRP and corticosteroid improved the functional and pain status in 30 and 180 days, but patients who had the PRP treatment showed a greater pain improvement.

How Much Does A Shot Of Orthovisc Cost

Knee Viscosupplementation  Non

If you want to use Orthovisc injections to treat your condition and your doctor agrees, you will need to fund your treatment out of pocket unless you have private health insurance that covers Orthovisc.

The cost of Orthovisc injections will vary depending on which provider and doctor you use. Generally, you should expect to pay between $550 and $1,300 for three 2-milliliter shots.

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Do Hyaluronate Knee Injections Work For Everyone

Osteoarthritis of the knee can lead to chronic pain, frustrating stiffness, and diminished ability to do the things you love. It can even affect your ability to get around normally. While many different treatments for knee osteoarthritis and other knee pain exist including oral pain medications, steroid injections, physical therapy, and dietary changes hyaluronate injections are a valuable option.

These injections, also called viscosupplements, involve putting a natural-like gel into your knee joint. This gel is much like the naturally occurring hyaluronic acid found in the synovial fluid that normally surrounds your joints. Hyaluronan in the injections acts like a shock absorber and lubricant.

This lubricant can help make painful joints move more smoothly, reducing discomfort and helping improve function. The injections can be a boon for some people, but they simply dont work for everyone. Read on to learn if its a treatment you should talk to us about trying.

You Are Sitting In The Orthopedists Office: The Discussion Turns To Cortisone

If you have been to your orthopedist recently and are planning treatment options or surgical options you may have been given a paper handout or webpage to visit or verbal advice on what to expect if you are getting a cortisone injection into your knee.

You may have been told:

The cortisone injection is to help you now, it is not a permanent solution.

  • It is to hold you over until a more effective plan can be introduced.

Physical therapy may be an option instead of the cortisone injection

  • You may then be suggested to physical therapy or continued physical therapy. As we will see below, research suggests that physical therapy would work better than cortisone. But while that may be true for some, it is likely that you are at the cortisone or repeated cortisone injection stage because physical therapy has not worked for you. So you have been to physical therapy and it has not helped you. That is why you are getting the cortisone shot. In fact, you may have tried, yoga, stretching, exercise, and massage for knee pain, and these treatments just didnt help.

You need to lose weight so the cortisone will work better

  • It should be noted that surgeons writing in The Journal of the American Academy of Orthopaedic Surgeons published findings in which they suggested:
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    Q: What If I Have A Knee Replacement Already

    A: If youve had either a total or partial knee replacement, there are certain treatments that we can still safely perform. However, no injections can be performed on knees that have already undergone operations.

    With other types of knee surgeries, like meniscus or ACL surgeries, the injections can be performed without any problems, if youre a good candidate.

    Bone Marrow Aspirate Concentrate Or Bone Marrow Concentrate Type Stem Cell Therapy

    Do PRP and stem cell injections work?

    Using stem cells taken from a patients bone marrow is becoming a therapy of interest due to the potential of these mesenchymal stem cells to differentiate into other types of cells such as bone and cartilage. This is not a new revolutionary treatment, this treatment has been studied and applied for many years. It is a difficult treatment for some doctors to give. You do need experience in all aspects of the treatment to give the patient the best chance at achieving their healing goals.

    Bone Marrow is the liquid spongy-type tissue found in the hallow of bones. It is primarily a fatty tissue that houses stem cells that are responsible for the formation of other cells. These mesenchymal stem cells , also called marrow stromal cells, can differentiate into a variety of cell types including osteoblasts , chondrocytes , myocytes , adipocytes , fibroblasts and others when reintroduced into the body by injection. Bone marrow also contains hematopoietic stem cells that give rise to the white and red blood cells and platelets.

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  • What Is A Prp Injection

    When a PRP injection for knee arthritis is performed, we take a small sample of your blood, and we place that sample into a centrifuge. The centrifuge will separate your blood into many different components. Towards the bottom of the tube we will find your PRP layer. We carefully remove that layer of PRP from the tube and place it into a syringe. After we clean and sterilize a small area of your knee we will numb the skin. Once the skin is numb we will inject the PRP into your knee. This is typically a 30 minute office visit.

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