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SYNVISC

Medicaid

It is important to verify your patient's Medicaid benefits to understand coverage and access guidelines for SYNVISC®. Some Medicaid agencies may require prior authorization for SYNVISC. State Medicaid agencies may reimburse for SYNVISC in the physician's office, pharmacy, or hospital outpatient settings.



Physician's Office
  • SYNVISC: State Medicaid agencies usually pay for SYNVISC administered in the office setting. The reimbursement percentage may vary according to the state guidelines. Some managed care Medicaid agencies may require use of a specialty pharmacy, in which case the specialty pharmacy will provide and bill Medicaid for the SYNVISC, and providers will bill for its administration.
  • SYNVISC administration: Medicaid payment policies for SYNVISC administration and associated office visits are similar to those under Medicare, with reimbursement structured according to a physician fee schedule.

For billing instructions in the office setting:
Download the Sample CMS-1500 Claim Form (PDF, 225K).

Download more Forms & Sample Letters, including a Blank CMS-1500 Claim Form (PDF, 17K).

Pharmacy
Some state Medicaid agencies require that SYNVISC be acquired through the retail pharmacy. In this setting, the pharmacy is reimbursed for SYNVISC using its unique National Drug Code (NDC) and according to the state agency's reimbursement rate for drugs and biologics. In these situations, patients pick up the SYNVISC from their local pharmacy and bring the product into their physician's office for administration.

Questions about Medicaid reimbursement?
Call SYNVISC ConnectionSM at 1-800-982-8292, M-F, 9 am -6 pm (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)