Does Medicare Pay for Knee Injections?

Osteoarthritis of the knee causes pain and stiffness that can severely limit your mobility and interfere with your daily life. Your doctor may prescribe knee injections to address these symptoms. Knee injections deliver fluid directly to the joint and can provide long-lasting relief from inflammation.

Medicare often pays for some types of knee injections for enrollees who meet established criteria.

Does Medicare Pay for Knee Injections?

Whether Medicare pays for knee injections depends on what type of injection your doctor recommends, how severe your symptoms are and what other treatments have already been used to address them.

For any type of knee injection, the doctor, hospital or clinic administering the injection must participate in Medicare for your plan to cover the expense. In addition, your premium payments must be up to date, and you may first have to satisfy a deductible.

What Is the Best Injection for Knees?

The best injection for knee osteoarthritis depends on the nature and severity of your symptoms and your overall health profile. Your doctor can recommend the right knee injection for your specific needs.

Three types of injections are commonly used to treat osteoarthritis:

• Corticosteroid injections work by easing inflammation. Their benefits typically last for two to three months. Often, this is the first type of injectable treatment that doctors recommend. If you have diabetes, your doctor may opt for another type of injection, as corticosteroids have the potential to increase blood sugar levels.
  
  
• Platelet-rich plasma or PRP injections use your own plasma to support the healing of knee cartilage and lessen inflammation.
  
  
• Hyaluronic acid injections increase your supply of a natural fluid present in your joints to provide lubrication and diminish inflammation.

All three types of knee injections must be administered by a doctor or other medical professional.

Does Medicare Cover Cortisone Knee Injections?

Injectable medications administered by a medical professional on an outpatient basis fall under Medicare Part B coverage. Generally, Medicare covers cortisone or corticosteroid injections for knee arthritis when a participating doctor deems that they're medically necessary.

How Often Does Medicare Pay for Cortisone Knee Injections?

Overuse of corticosteroid injections can lead to cartilage damage. As a result, doctors typically recommend no more than three cortisone shots per year. Medicare typically covers the cost of corticosteroid injections given on this dosing schedule.

Does Medicare Cover PRP Injections?

As of October 2023, Medicare doesn't cover PRP injections for any condition. In the ruling regarding the therapy, Medicare states that while early studies into the benefits of the shots for the management of osteoarthritis are promising, more research is required to prove their effectiveness. Until such evidence exists, Medicare is likely to continue to exclude PRP injections from coverage.

Does Medicare Part B Cover Hyaluronic Acid Injections?

Medicare Part B may cover hyaluronic acid injections for the knee if you have symptoms of knee pain or stiffness that interfere with one or more daily living tasks like sleeping comfortably or standing for long periods of time. In addition, prior to coverage, your doctor must:

• Perform imaging tests and other diagnostic testing to rule out any other possible cause for your symptoms and confirm that you have osteoarthritis of the knee
  
  
• Try other treatments like physical therapy and over-the-counter pain relievers to manage your symptoms for at least three months
  
  
• Attempt to treat your symptoms by either removing fluid from your knee or prescribing corticosteroid injections

How Often Does Medicare Pay for Hyaluronic Acid Injections?

Medicare usually requires that you wait at least six months between hyaluronic acid injections. Your arthritis pain or stiffness must return for you to qualify for repeat injections. Your doctor must verify that you saw a noticeable decrease in symptoms or that you were able to rely less on other treatments such as pain relievers following the previous injection.

When Does Medicare Part A Pay for Knee Injections?

Medicare Part A may cover corticosteroid or hyaluronic acid injections that you receive while admitted to a hospital or long-term care facility. Any injections performed on an outpatient basis are paid through Medicare Part B.

Do Medicare Advantage Plans Cover Knee Injections?

By law, Medicare Advantage plans must pay for at least as much as Medicare Parts A and B do. Generally, you can expect your plan to cover corticosteroid and hyaluronic acid injections under the above guidelines. Your plan may also provide more coverage than Original Medicare.

Depending on the type of insurance you have, you may need to receive the injection from a doctor, hospital or clinic that is in your plan's network.

How Much Will Knee Injections Cost With Medicare?

The cost of corticosteroid and hyaluronic acid injections varies based on the specific medication your doctor prescribes and where you live. Which portion of Medicare pays for your injections determines how much you'll pay out of pocket.

• Under Medicare Part A, you generally only pay coinsurance once your stay in a hospital or long-term care facility exceeds 60 days.
  
  
• Under Medicare Part B, you're usually responsible for 20% of the cost of knee injections, with Medicare paying the remaining 80%.
  
  
• Under Medicare Part C, you'll likely have to pay a copay or coinsurance. Consult your plan for more information.

Along with the cost of the injections, you may have to pay for office visits, X-rays, MRIs, other diagnostic testing and additional fees.

Do Medicare Supplement Plans Pay for Knee Injections?

Your Medicare Supplement or Medigap plan may help pay for all or some of the 20% that you're expected to pay out of pocket for corticosteroid or hyaluronic acid knee injections under Medicare Part B rules.