Diagnosis: Bilateral knee osteoarthritis

Treatment: Medication-Euflexxa knee injections

The insurer denied the coverage for Euflexxa knee. The denial was upheld.

This is a female patient with bilateral knee osteoarthritis. Treatment included prior Euflexxa knee injections. Currently under review is the insurer's denial for requested additional Euflexxa knee injections.

Viscosupplementation is a therapeutic modality proposed for the treatment of osteoarthritis based on the physiologic importance of hyaluronan in synovial joints. Its therapeutic goal is to restore the visco-elasticity of synovial hyaluronan, thereby decreasing pain, improving mobility and restoring the natural protective functions of joint hyaluronan. Euflexxa is one of several hyaluronic acid products available in the USA.

Based on the above, the medical necessity for Euflexxa Intra-Articular Injections is not substantiated. The insurer's denial is upheld.