What you should know about private medical insurers
Private medical insurers may sometimes give the impression that they will not reimburse OSTENIL® or OSTENIL® PLUS injections, and, as a result, you may be led to offer OSTENIL® injections only for self-funding patients.
However, depending on the patient's insurance policy, the affected joint, and other potential factors, Bupa, Aviva, AXA-PPP and VitalityHealth will fund viscosupplementation if you use the correct specific code that the insurers require, . Please have a look at this website: www.ccsd.org.uk. The "Clinical Coding & Schedule Development Group" provides the specific codes used by the four major insurers (BUPA, Aviva, AXA-PPP, and VitalityHealth) for injecting a viscosupplement into a joint with or without guidance.
AXA-PPP, Aviva, and VitalityHealth:
The relevant codes for AXA-PPP, Aviva and VitalityHealth can be found by clicking the ‘procedural’ (green) tab and entering ‘Viscosupplement’ in the search box. The codes that come up are:
W9032 – Injection of viscosupplement into joint WITH image guidance
W9033 – Injections of viscosupplement into joints WITH image guidance (bilateral)
W9042 – Injection of viscosupplement into joint
W9043 - Injections of viscosupplement into joints (bilateral)
The code for BUPA is AA663, which has to be used in conjunction with W9030 (joint injection under guidance), or W9040 (joint injection without guidance). If you go to the individual insurers websites then you can also see how much they pay for using each of the codes and what restrictions there are.
Do insurers only fund knee injections?
Sometimes an insurer may say that they will only cover the cost of a viscosupplement injected into the knee and not any other joint. However, on the codes schedule it does not specify that the related codes are only for the knee. This means injections into other joints, i.e. hip, shoulder, ankle, etc, should also be covered by the insurers.
However, the insurers will have their own specific policy regarding applicable clinical circumstances and products to be used.