HCPCS code for Synvisc and Synvisc-One hyaluronan knee injections, billed per 1 mg rather than per injection.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- Knee
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Product (Synvisc or Synvisc-One), mg injected, and units billed
- Radiographic knee osteoarthritis
- Failed conservative therapy with dates
- Laterality for each procedure
- NDC and lot number
- Response and interval for repeat courses
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
J7325 covers Synvisc (three weekly 16 mg injections) and Synvisc-One (a single 48 mg injection). Unlike most hyaluronan codes, J7325 is billed per 1 mg. Synvisc-One is 48 units. Each Synvisc injection is 16 units. Billing 1 unit for Synvisc-One is one of the most common underpayments in ortho drug billing.
The procedure goes on its own line: 20610 or 20611, with RT or LT. A bilateral Synvisc-One visit carries 96 units of drug. Medicare takes the procedure once with modifier 50. Some commercial plans want RT and LT lines instead, with 48 units per side.
Payers want radiographic knee OA, failed NSAIDs or analgesics, an exercise or PT trial, and usually a steroid injection first. Repeat courses generally need six months and evidence the last course helped. An E/M on the same day needs a separate problem and modifier 25. These are single-dose syringes, so add JZ when the full dose is given.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
HOPD (APC 0874) Hospital outpatient department | $7.56 |
Common denial reasons
The recurring reasons claims for CPT J7325 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed as 1 unit instead of per mg
- Repeat course within six months
- Conservative therapy not documented
- Missing JZ modifier
- Bilateral procedure billed in a format the payer does not accept (modifier 50 vs RT and LT lines)
- Hip or shoulder injection billed for knee-only coverage
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many units of J7325 for Synvisc-One?
02How many units of J7325 for each Synvisc injection?
03How do you bill bilateral Synvisc-One?
04How often can Synvisc-One be repeated?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02CMS Medicare Part B Drug Average Sales Price files
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
Mira Scribe
Mira Scribe notes capture the product, dose, side, and prior treatment history, so Synvisc units and medical necessity line up on the claim.
See how Mira captures CPT J7325 documentation