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SYNVISC® Reimbursement Billing Codes

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
58468-0090-01 SYNVISC
58468-0090-03 Synvisc-One
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
510 Clinic visit

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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