Wiki Gel-One J7326

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tsagememortho

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Hello! Anyone billing for Gel-One (Hyaluronan or derivative, gel-one, for intra-articular injection, per dose) and have any experience getting it paid? Thanks!
 
Gel One

We bill:
20610 LT
J7326

It is billed as only one unit as it comes in a 30 mg syringe. The only payer I have trouble getting paid for is Medicaid. Your diagnosis needs to be osteoarthritis. It is only payable once every 6 months and only for knees.
 
Be very careful when billing an E&M with these viscosupplementation drugs.

As always, it must be documented as a separate service in order to bill an injection with an E&M; the insurance companies are very quick to deny these viscosupplementation injections and E&M's as inclusive even with the modifier 25 to unbundle.

Also, J7325 is for billing Synvisc and Synvisc One NOT Gel-One which is billed with J7326.

Synvisc is billed at 16 units per knee (32 for bilat) for the Synvisc three shot or 48 units per knee (96 for bilat) for the Synvisc One shot.

Gel-One would be billed as 1 unit per knee.
 
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