Prior Authorization Change - May 23, 2022
Date: 04/20/22
Effective May 23, 2022, procedure codes for hyaluronate injections will require prior authorization. Prior authorization is administered through the medical benefit, rather than the pharmacy benefit.
To submit a request for medications that will be administered by a provider (i.e. biopharmacy, home health, outpatient, injectable or infusible medications), use the form on our Provider Pharmacy page.
List of procedure codes that will require an authorization starting May 23, 2022:
Product & Procedure Code
- Durolane - J7318
- Hyalgan/Supartz - J7321
- Euflexxa - J7323
- Orthovisc - J7324
- Synvisc/Synvisc One - J7325
- Gel-One - J7326
- Monovisc - J7327
- Gelsyn-3 - J7328
- Genvisc 850 - J7320
- Hymovis - J7321
- Hyronan - J7322
- Triluron - J7332
- Trivisc - J7329
- Visco-3 - J7333
- Synojoynt - J7331
If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Customer Service at 1-877-644-4623.