Does Medicare Cover Knee Injections?
Learn if and how Medicare covers knee injections, understanding coverage criteria and patient financial responsibilities.
Knee pain can significantly impact daily life, often stemming from conditions like osteoarthritis, where the protective cartilage in the knee joint wears down. Many individuals seek relief through various treatment options, and knee injections are a common approach to alleviate discomfort and improve function. These injections involve delivering substances directly into the knee joint to reduce inflammation, provide lubrication, or promote healing. Understanding how Medicare covers these procedures is important for beneficiaries to manage their healthcare expenses effectively.
General Medicare Coverage Principles for Medical Services
Medicare generally covers medical services that are considered reasonable and necessary for diagnosing or treating an illness or injury. The primary component of Medicare that applies to outpatient medical services, including doctor’s visits, preventive care, and certain durable medical equipment, is Medicare Part B. This part of Medicare ensures that beneficiaries receive coverage for a wide range of services provided outside of a hospital inpatient setting. The guiding principle for all Medicare coverage is “medical necessity,” meaning the service or supply must meet accepted standards of medical practice for the condition being treated.
Medicare’s determination of medical necessity is based on evidence-based practices and clinical guidelines established by the Centers for Medicare & Medicaid Services (CMS). This framework helps ensure that treatments are appropriate and effective for the diagnosed condition. Healthcare providers must document that the services are needed for the diagnosis or treatment and align with recognized medical standards. If a service does not meet these criteria, Medicare typically will not provide coverage.
Specific Knee Injection Coverage Under Medicare
Medicare Part B covers knee injections when medically necessary for the treatment of osteoarthritis of the knee. Two common types of knee injections are corticosteroid and hyaluronic acid (viscosupplementation) injections. Corticosteroid injections reduce inflammation and pain, often providing relief for several months. These are frequently considered a first-line injectable treatment for knee osteoarthritis.
Hyaluronic acid injections, also known as viscosupplementation, supplement the natural fluid in the knee joint, improving lubrication and cushioning. These injections restore the viscosity of synovial fluid, which often breaks down in individuals with osteoarthritis. Coverage for both types of injections applies to FDA-approved substances administered by a qualified healthcare professional.
For hyaluronic acid injections, Medicare may cover a repeat series if initial criteria are met, symptoms return, and there was a positive response to previous injections. A minimum of six months must pass since the prior series of injections for a new series to be considered. Doctors usually recommend no more than three corticosteroid injections per year into the same joint to avoid potential cartilage damage.
Conditions for Coverage and Patient Costs
For Medicare Part B to cover knee injections, several conditions must be met:
Injections must be prescribed by a licensed physician and administered by a qualified healthcare professional, such as a doctor, physician assistant, or nurse practitioner.
Administration must occur in an appropriate setting, such as a doctor’s office or an outpatient clinic, and the healthcare provider must participate in Medicare.
Documentation is important for coverage, often requiring evidence that other conservative treatments, such as physical therapy, pain medication, or assistive devices, have been tried and were unsuccessful or are not suitable for the patient.
Medical imaging confirming the osteoarthritis diagnosis is also frequently required.
For certain injections, particularly some hyaluronic acid derivatives, prior authorization may be recommended to ensure coverage.
Beneficiaries with Original Medicare Part B are responsible for an annual deductible. In 2025, this deductible is $257, and the beneficiary pays 100% of the Medicare-approved amount until this deductible is met. After the deductible is satisfied, Medicare Part B covers 80% of the Medicare-approved amount. Supplemental insurance plans, such as Medigap policies or Medicare Advantage plans, can help cover these out-of-pocket costs.