To obtain reimbursement for Synvisc-One® and SYNVISC®, you must submit a property coded claim form. Below are the billing codes commonly used for Synvisc-One and SYNVISC and its administration.
|Synvisc-One and SYNVISC Billing Codes|
|M17.0||Bilateral primary osteoarthritis of knee|
|M17.10||Unilateral primary osteoarthritis, unspecified knee|
|M17.11||Unilateral primary osteoarthritis, right knee|
|M17.12||Unilateral primary osteoarthritis, left knee|
|M17.2||Bilateral post-traumatic osteoarthritis of knee|
|M17.30||Unilateral post-traumatic osteoarthritis, unspecified knee|
|M17.31||Unilateral post-traumatic osteoarthritis, right knee|
|M17.32||Unilateral post-traumatic osteoarthritis, left knee|
|M17.4||Other bilateral secondary osteoarthritis of knee|
|M17.5||Other unilateral secondary osteoarthritis of knee|
|M17.9||Osteoarthritis of knee, unspecified|
|J7325||For Synvisc-One and SYNVISC, per 1mg|
|Synvisc-One||48 in Units field of CMS-1500 Claim form or electronic equivalent|
|SYNVISC||16 in Units field of CMS-1500 Claim form or electronic equivalent|
|20610||Arthrocentesis, major joint or bursa * Include modifiers -RT, -LT or 50 (bilateral)|
|99211 to 99215||Office visit for established patients|
|99201 to 99205||New patient office or other outpatient visit|
|Revenue Codes (used in hospital setting only)|
|R636||Drugs requiring detailed coding|
Providers are responsible for the selection of appropriate codes depending on clinical diagnosis. Information in the above table provides a general framework for understanding possible coding alternatives. It should not be used as a substitute for a healthcare professional's own judgment.
Providers retain sole responsibility for determining reimbursement and insurance issues related to their patients and for ensuring the accuracy of their claim submissions. Sanofi cannot be responsible for failure of a provider to obtain reimbursement.
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