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Thread: Medicare Criteria for Euflexxa medication?

  1. #1

    Question Medicare Criteria for Euflexxa medication?

    AAPC: Back to School
    Does anyone know the Medicare criteria for using Euflexxa medication?
    We use Supartz and Synvisc, but can't find the criteria for charging patients for Euflexxa (if we order medication).
    Thanks so much in advance for any help.

  2. #2
    Join Date
    Apr 2007
    North Carolina


    The only approved indication for this type of treatment (NC Medicare Carrier) is osteoarthritis of the knee as supported by one of the following ICD-9 codes that should submitted of the claim for this service:

    715.16 Osteoarthrosis, localized, primary, lower leg

    715.26 Osteoarthrosis, localized, secondary, lower leg

    715.36 Osteoarthrosis, localized, not specified whether primary or secondary, lower leg

    715.96 Osteoarthrosis, unspecified whether generalized or localized, lower leg

    This is applicable to Euflexxa, Hyalgan, Supartz, Orthosvisc and Synvisc

  3. #3


    Thank you so much.
    I just wanted to be sure Euflexxa was included with Hyalgen, Synvisc and Supartz and would be covered by Medicare with the Osteoarthritis guidelines, same as Synvsc and Supartz.

  4. #4

    Question Actual Medicare guidline that mentions Euflexxa?

    Would you happen to know where I could find the acutual Medicare guideline that mentions Euflexxa in writing?
    Thanks again so much.

  5. #5
    Join Date
    Apr 2007
    North Carolina


    I'll list a couple since I don't know who covers your Medicare region....




    (Keep in mind that the last link does not have the updated "J" codes but the policy is still the same)

  6. #6

    Wink Thank you!

    Thank you so much.
    That is what I needed. I really appreciate your help.
    Lynn, CPC

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