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Medicare Reimbursement

SYNVISC® (hylan G-F 20) /Synvisc-One® is eligible for reimbursement under all Medicare Part B plans.

Synvisc-One® and SYNVISC® Medicare coverage

Synvisc-One® and SYNVISC® Medicare reimbursement

Within the hospital outpatient department, Synvisc-One and SYNVISC are covered as Separately Covered Outpatient Drugs (SCODs), which are paid at a rate of ASP + 4.3%. Of this allowable rate, Medicare will reimburse 80%, and the patient or patient's secondary insurer is responsible for the remaining 20% coinsurance.


Medicare also reimburses for the administration of Synvisc-One and SYNVISC when provided in the hospital outpatient setting. Under the OPPS, Medicare reimburses the hospital outpatient department for CPT 20610 (arthrocentesis, aspiration, and/or injection of a major joint or bursa) under a fixed procedure APC payment rate. State payment rates will vary based on geographic wage indices.

Physicians should bill Medicare separately for their professional services given in the hospital outpatient setting that are associated with Synvisc-One and SYNVISC.

Bilateral procedures:

When a bilateral procedure is done, the reimbursement allowable to physicians and hospitals is 150% of the payment for CPT 20610. Of this amount, Medicare will reimburse 80%, and the patient or patient's secondary/supplemental insurer will reimburse the remaining 20% coinsurance.

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Please refer to Billing Codes for other relevant codes needed to ensure proper claim submission for Synvisc-One and SYNVISC

Providers retain sole responsibility for determining reimbursement and insurance issues related to their patients and for ensuring the accuracy of their submission claims. Sanofi cannot be responsible for failure of a provider to obtain reimbursement.

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Specialty Pharmacy Forms

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