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SYNVISC

Coding Overview

To obtain reimbursement for SYNVISC®, you must submit a properly coded claim form. Below are the billing codes commonly used for SYNVISC and its administration.

SYNVISC® (hylan G-F 20) Billing Codes
ICD-9-CM Diagnosis codes
International Classification of Diseases, Ninth Revision, Clinical Modification indicates the patient's condition.
715.16 Osteoarthritis, localized, primary, lower leg
715.26 Osteoarthritis, localized, secondary, lower leg
715.36 Osteoarthritis, localized, unspecified as to primary or secondary, lower leg
715.96 Osteoarthritis, localized, unspecified whether generalized or localized, lower leg
NDC Pharmacy codes
National drug codes (NDCs) are used by private payers and Medicaid to reimburse for pharmacy products.
58468-0090-01 SYNVISC, kit configuration (three syringes)
58468-0090-02 SYNVISC, individual syringe blister pack tray
HCPCS Drug and biologic billing codes
SYNVISC is reimbursed as a drug using a unique Health Care Common Procedural (HCPCS) code established by the Centers for Medicare and Medicaid Services (CMS).
J7322 SYNVSIC, inj, per dose
* include modifiers -RT or -LT
CPT Procedure codes (CPT)
Current Procedural Terminology (CPT) codes are used to bill for the administration of SYNVISC and related professional services.
20610 Arthrocentesis, major joint or bursa
* include modifiers -50 for bilateral injections (as necessary)
99211 to 99215 E&M office visit for established patients
99203 New patient office visit
73564 Knee x-ray
Revenue Revenue codes
Hospital codes used to bill surgical procedures, professional services, and supplies. Revenue codes are billed alongside the appropriate HCPCS and CPT procedure codes.
639 Drugs requiring detailed coding
510 Clinic Visit

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Providers are responsible for the selection of appropriate codes depending on clinical diagnosis. Information in the above table provides a general framework for understanding possible coding alternatives. It should not be used as a substitute for a healthcare professional’s own judgment.

Do you have questions about insurance coverage, filing claims, or billing?
Check with specific patient insurance carriers or call SYNVISC ConnectionSM at
1-800-982-8292, M-F, 9am-6pm (EST).

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 Safety Information

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

SYNVISC is contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the knee. Use caution when using SYNVISC 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 joint to be treated. Patients should be advised to avoid strenuous or prolonged weight-bearing activities after treatment. Strict adherence to aseptic technique must be followed to avoid joint infection. The safety and effectiveness of SYNVISC in children and in pregnant or lactating women have not been established. It is unknown whether SYNVISC is excreted in human milk.

View the Complete Prescribing Information for SYNVISC (PDF, 146k)