When is authorization required for HCPCS/ CPT codes 20610 and 20611?

Practices are only required to seek authorization for these codes (20610, 20611) when associated with Viscosupplementation therapy of the knee*/ injection of any hyaluronic acid product. When submitting the authorization request, include codes 20610 or 20611 in addition to the J-code for the product being injected (e.g. Orthovisc: J7324 or Monovisc: J7327). Click here to view a list of Humana's preferred Viscosupplementation products. 

Authorization IS NOT REQUIRED for 20610 or 20611 when used in conjunction with any procedure other than viscosupplementation (e.g., corticosteroid injection, joint space aspiration).

 

Type of Request / Codes What to do

Viscosupplementation: Injection codes 20610, 20611

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Preferred Drug (w/ J-code)

Submit BOTH through Cohere.

Viscosupplementation: Injection codes 20610, 20611

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Non-Preferred Drug

  • Submit the injection code through Cohere.
  • Submit the non-preferred drug with Humana.
Injection (20610) that is NOT associated with viscosupplementation Prior authorization is NOT required

*Viscosupplementation is not FDA-approved for any indications other than osteoarthritis of the knee. However, requests for viscosupplementation at another body site can still be submitted through Cohere, will pend for review, and likely be denied upon final review unless withdrawn.

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