J7324 – Orthovisc – 30 mg injection: 1 billing unit = 30 mg
Maximum 8 injections per 180 days
4 units every 180 days per knee
30 mg once weekly x 4 doses
NDC Number 59676-0360-01
ICD-10 Codes that are Covered
| ICD-10 Code | Description |
|---|---|
| M17.0 | Bilateral primary osteoarthritis of knee |
| M17.11 | Unilateral primary osteoarthritis, right knee |
| M17.12 | Unilateral primary osteoarthritis, left knee |
| M17.2 | Bilateral post-traumatic osteoarthritis of knee |
| M17.31 | Unilateral post-traumatic osteoarthritis, right knee |
| M17.32 | Unilateral post-traumatic osteoarthritis, left knee |
| M17.4 | Other bilateral secondary osteoarthritis of knee |
| M17.5 | Other unilateral secondary osteoarthritis of knee |
| M17.9 | Osteoarthritis of knee, unspecified |