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  • Patient Access form

  • Use the Patient Access form to complete Insurance Verification (IV) or Specialty Pharmacy Provider (SPP) Triage requests. 

    Download the form.

  • HCPCS Code J7325
  • HCPCS code per 1 mL.

    Click here for additional code information on Synvisc-One and SYNVISC.

SYNVISC ConnectionSM Reimbursement Support

SYNVISC ConnectionOur goal is to ensure that patients have hassle-free access to Synvisc-One® and SYNVISC® (hylan G-F 20). That’s why we created SYNVISC Connection; a comprehensive reimbursement support program designed to help you simplify the reimbursement process.

Reimbursement Specialists are available Monday– Friday 9am-8pm est and can be accessed via email, phone, fax and the web.

To contact a Reimbursement Specialist please Call: 1-800-982-8292 or Fax: 1-800-508-8083.

SYNVISC Connection offers the following services:

Insurance Verification (IV)

Specialty Pharmacy Provider (SPP) Triage

  • Verifies that patients’ plan allows the use of SPP and which in-network specialty pharmacies are available
  • Transfers completed Patient Access form for Synvisc-One or SYNVISC to the SPP for fulfillment
  • Provides necessary SPP forms in the event the SPP requires use of a specific form
  • To complete the SPP Triage request please download the Patient Access form.
  • Printable Resource: Specialty Pharmacy Provider Flowchart

eServices

  • Provides online access to SYNVISC Connection
  • Electronically submit IV and Prior Authorization requests
  • Manage patients, providers, and multiple office locations through one user profile
  • Generates custom activity reports
  • Register at www.synvisceservices.com
  • Printable Resource: eServices

Prior Authorization (PA) Assistance

  • Verifies payer PA requirements and assists in obtaining authorization for Synvisc-One and SYNVISC
  • Provides office with any required insurer-specific forms and helps to ensure the PA is submitted and reviewed by the payer
  • Printable Resources: Prior Authorization, Prior Authorization Sample Results Form

Clean Claims Program

  • Confirms accurate coding of medical claim prior to submission
  • Follows up with payer to verify claim is processed and paid
  • Disputes payer decision to deny or underpay claim and works with insurer to resolve coding issues
  • Download the Clean Claims Form
  • Printable Resource: Clean Claims Services

Additional Printable Resources

Indication

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.

Important Safety Information

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)