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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

January 2015

Appropriate Coding for Monovisc 


Previously, the hyaluronate injection Monovisc did not have a specific HCPCS code and claims were billed under an unlisted J code. Now, a specific HCPCS code is available, and effective immediately, claims for Monovisc should be billed using the J7327 code.

As a reminder, prior authorization is required for all hyaluronate preparations administered to members of Harvard Pilgrim’s HMO, POS, and PPO products. Harvard Pilgrim covers FDA-approved hyaluronate preparations that are medically necessary to treat pain associated with osteoarthritis of the knee in patients who have not gotten adequate relief from simple analgesics and conservative treatment. Coverage is limited to a maximum of 4 courses of treatment in 36 months. Synvisc-One and Euflexxa are the preferred agents.

For further details, please refer to our Hyaluronate Preparations for Osteoarthritis of the Knee Medical Review Criteria. To request prior authorization, please fax a completed Hyaluronate Preparations for OA of Knee Prior Authorization Request form to 800-232-0816. You may also find it helpful to enter your request in HPHConnect to receive a tracking number and check the status of the request. Our Outpatient Pharmacy Service Transactions User Guide is available to aid you in entering your request in HPHConnect.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Contributing Writer

Kristin Edmonston,
Production Coordinator