Billing and Reimbursement

The Centers for Medicare and Medicaid Services (CMS) issued a new shared HCPCS billing code for Synvisc-One^® and SYNVISC^® (hylan G-F 20) effective for dates of service on or after January 1^st 2010.

J7325, HYALURONAN OR DERIVATIVE, SYNVISC OR SYNVISC-ONE, FOR INTRA-ARTICULAR INJECTION, 1 MG

2010 billing instructions for Synvisc-One and SYNVISC:

Synvisc-One Jcode update

The unique J-code assigned to Synvisc-One and SYNVISC, J7325, significantly streamlines the reimbursement process. Synvisc-One and SYNVISC are eligible for reimbursement by commercial payers and Medicare. However, specific policies vary across insurers and from plan to plan. Use the links tbelow to find reimbursement information for the following payer types:

Commercial Payers – Understand the reimbursement guidelines for commercial payers, including specialty pharmacy.
Medicare – Find out about Medicare reimbursement across different settings of care
Medicaid – Understand general reimbursement requirements across state Medicaid agencies

Providers retain responsibility for determining reimbursement and insurance issues related to their patients. Genzyme cannot be responsible for failure of a provider to obtain reimbursement.

Important Treatment Considerations

SYNVISC^® (hylan G-F 20) and Synvisc-One^® (hylan G-F 20) are indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non pharmacologic therapy and simple analgesics, e.g., acetaminophen.

SYNVISC and Synvisc-One are contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the target knee. Use caution when injecting SYNVISC or Synvisc-One in patients allergic to avian proteins, feathers, or egg products; who have evidence of venous or lymphatic stasis in the leg to be treated; or who have severe inflammation in the knee to be treated.

Patients should be advised to avoid strenuous or prolonged weight-bearing activities for approximately 48 hours after treatment. Aspiration of any effusion prior to injection is highly recommended. Strict adherence to aseptic technique must be followed to avoid joint infection. The safety and effectiveness of SYNVISC and Synvisc-One have not been established in children or in pregnant or lactating women. It is unknown whether SYNVISC or Synvisc-One is excreted in human milk.

For SYNVISC
In clinical trials, the most commonly reported adverse events were transient local pain, swelling, and/or effusion in the injected knee. In some cases, these symptoms have been extensive. Other side effects such as rash have been reported rarely.

View the Complete Prescribing Information for SYNVISC (PDF)

For Synvisc-One
The most commonly reported related local adverse events were transient, mild-to-moderate arthralgia, arthritis, arthropathy, injection site pain and joint effusion. No serious adverse events were reported in clinical trials in knees injected with Synvisc-One. Serious local adverse events have been reported only rarely in post-marketing use. Repeat treatment did not affect the safety profile. In the pivotal clinical trial, there was one related systemic event of syncope. The most common systemic side effects irrespective of relationship to Synvisc-One were headache, back pain, nasopharyngitis and influenza. Systemic adverse event profiles were similar between patients in the Synvisc-One and Saline Control groups.

View the Complete Prescribing Information for Synvisc-One (PDF)