Does Medicare cover knee injections

Does Medicare Cover Knee Injections for Joint Pain? 

Osteoarthritis (OA) of the knee is a degenerative joint disease prevalent among adults who fall in the 50-plus age bracket. This chronic condition leads to cartilage breakdown in between joints. When the cartilage can no longer protect the bone’s surface, the bones tend to rub and grind, leading to pain, swelling and stiffness. 

Risk factors outlined by the Arthritis Foundation include age, gender (more common in women), obesity, past and current injuries, repetitive stress, genetics, bone malformation and certain metabolic diseases. 

The American Academy of Orthopaedic Surgeons (AAOS) reports that “osteoarthritis of the knee is one of the leading causes of disability in the United States.” No cure has been found, but the condition can be treated to help you work through the pain and continue to live an active life.

Remedies for knee pain

The Arthritis Foundation describes three categories of treatments for OA of the knee: self-care, surgery or medication. Self-care strategies incorporate ice or heat, weight loss, exercise, physical therapy, acupuncture, massage, topical creams and supportive devices like a cane or brace. Surgery would be a last-resort option if nothing else alleviates the pain. A comprehensive plan would encompass a meld of treatments, therapies and self-care approaches.  

Your doctor may suggest non-steroidal anti-inflammatory drugs (NSAID), steroid injections (three to four annually) or lubrication injections in the form of hyaluronic acid (HA). Chronic pain may be treated with Duloxetine, an oral medication sold under the brand name of Cymbalta. For rapid relief, doctors will administer injections directly into the knee joint, which can be done in the doctor’s office. 

Medicare Part B coverage

Prescription drugs are mostly covered under Part D. When you enroll in Part D, your plan provides you with a formulary. This is a tiered list of drugs the plan will cover. Tiers can range from generic to specialty drugs with corresponding copayments. Your formulary should include self-administered drugs, which are medications you take on your own, such as those prescribed for pain or chronic conditions. 

Medicare Part B covers limited drugs in hospital outpatient settings. These facilities could be an observation area, a surgery center, an emergency room or a pain clinic. Part B also covers certain drugs your health care practitioner would administer in a physician’s office. Injectable and infused drugs that are not self-administered are covered under Medicare Part B when given by a licensed medical provider. 

Usually, when Medicare covers drugs you receive in a physician’s office or pharmacy, the Part B deductible applies. Once the deductible is met, you are responsible for 20% of the Medicare-approved amount. Pharmacies and doctors accepting assignment from Medicare will charge you no more than the deductible and copayment or coinsurance. 

Resources

To learn more about joint injections, visit the Arthritis Foundation at arthritis.org.