Nov. 21, 2025
Medical necessity review criteria for viscosupplementation of osteoarthritis of the knee will change for members with Blue Cross Community Health PlansSM, effective Jan. 1, 2026.
What’s changing: Effective Jan. 1, we will follow the Centers for Medicare & Medicaid Services’ local coverage determination guidelines for prior authorization for osteoarthritis knee injections. Refer to LCD L39260 − Hyaluronic Acid Injections for Knee Osteoarthritis for specific criteria information.
Important reminders: Always check eligibility and benefits through Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.
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