HCPCS Code J7326: Hyaluronan or Derivative, Gel-One, For Intra-Articular Injection, Per Dose

Learn about the benefits and considerations of hyaluronan injections for knee pain relief. Know more about billing this for your clinical practice.

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## **What is the HCPCS code J7326?** Knee osteoarthritis affects millions of patients worldwide, causing significant knee pain and limiting functional capacity (Cui et al., 2020). When conservative nonpharmacologic therapy and oral medications fail to provide adequate relief, intra-articular hyaluronic acid injections offer an important treatment option. HCPCS code J7326 is used to identify the supply of Gel-One, a hyaluronan or derivative gel product manufactured by Zimmer Biomet for intra-articular injection per dose. This code specifically covers the medication component of viscosupplementation therapy used to treat osteoarthritis of the knee. Gel-One is a unique formulation among hyaluronic acid derivatives because it requires only a single intra-articular injection rather than a series of multiple treatments. The product contains hyaluronic acid that provides extended joint lubrication and potential anti-inflammatory effects within the knee joint. Unlike other hyaluronans, which may require weekly treatments over several weeks, Gel-One's formulation allows for convenient single-dose administration (Zimmer Biomet, 2025). J7326 applies to patients with symptomatic osteoarthritis who have failed to respond adequately to conservative methods, including physical therapy, weight management, oral NSAIDs, and topical treatments such as topical NSAIDs and topical capsaicin. Certain conditions preclude injections with Gel-One. This includes active joint infection, severe infections in the target area, bleeding disorders that increase procedural risks, and known hypersensitivity to hyaluronic acid products. The presence of severe joint swelling or unstable joint conditions may also influence treatment decisions. Healthcare professionals must then carefully assess each patient's overall health status, including any history of rheumatic diseases that might complicate treatment or affect expected outcomes.

## **HCPCS code J7326 documentation requirements** For HCPCS code J7326, clinicians must document the medical necessity of Gel-One for osteoarthritis of the knee, including insufficient response to conservative treatments (e.g., NSAIDs, analgesics, physical therapy). More specifically, documentation should include the following: - Clear documentation of the primary diagnosis, typically knee osteoarthritis, with appropriate ICD-10 coding. For unilateral secondary osteoarthritis or bilateral secondary osteoarthritis cases, include specific laterality and underlying cause. - Clinical examination findings and radiological evidence should support the diagnosis. - Documentation must demonstrate that knee pain and functional limitations significantly impact the patient's daily activities, including challenges with prolonged standing, walking, or other essential functions.

## **HCPCS code J7326 billing requirements** When billing J7326, providers should note the following considerations: - J7326 represents the supply of Gel-One and is billed as only one unit per knee treated. - The billing must accurately reflect the actual medication administered, and healthcare professionals should maintain detailed records of lot numbers, expiration dates, and administration details as specified in the package insert. - The injection procedure itself requires separate billing using appropriate CPT codes, typically 20610 for arthrocentesis and injection of a major joint without imaging guidance, or 20611 when ultrasound guidance is used. - Laterality modifiers are essential when billing J7326, with RT (right side) and LT (left side) modifiers clearly identifying which knee received treatment. For patients requiring bilateral treatment, separate lines must be used for each knee (as preferred by Medicare and most other payers), or a single line with the 50 modifier, depending on the payer's specific requirements. - When evaluation and management services are provided on the same day as the injection, modifier 25 may be appropriate if the E/M service is separate and distinct from the injection procedure decision (Centers for Medicare & Medicaid Services, 2024).

## **Other relevant codes** - **J7318**: Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg - **J7320**: Hyaluronan or derivative, GenVisc 850, for intra-articular injection, 1 mg - **J7321**: Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose

### **References** Centers for Medicare & Medicaid Services (2024). Billing and coding: Intraarticular knee injections of hyaluronan. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56157&ver=15& Cui, A., Li, H., Wang, D., Zhong, J., Chen, Y., & Lu, H. (2020). Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinical Medicine, 29-30, 100587. https://doi.org/10.1016/j.eclinm.2020.100587 Zimmer Biomet (2025). Gel-One® cross-linked hyaluronate. https://www.zimmerbiomet.com/en/products-and-solutions/products/restorative-therapies/gel-one.html

Frequently asked questions

Each single injection of Gel-One is billed as 1 unit, corresponding to the entire 30 mg dose—consistent with its “per dose” designation.

Yes. If the E&M is medically necessary and separately documented, you may bill it with modifier -25. If not, billing the E&M on subsequent visits without a distinct problem is not permitted.

Corticosteroid injections are the most common first-line injectable treatment for joints other than the knee. They combine a corticosteroid (like triamcinolone or methylprednisolone) and a local anesthetic to provide rapid, temporary relief by significantly reducing joint inflammation.