Summary
Subtalar arthroereisis is considered investigational. The procedure places an implant in the sinus tarsi, which is a canal between the talus and the calcaneus, to correct excessive talar displacement and calcaneal eversion by reducing pronation across the subtalar joint. Investigative procedures are not considered medically necessary because they are not yet recognized as a generally accepted standard of good medical practice for the treated condition.
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What to do
Action · 3 steps
01Billing team: Check the member's specific benefit plan language before billing subtalar arthroereisis, because the coverage guidelines in the Medical Policy Manual should not be used in lieu of that language.
02The code reference lists CPT 28899 (unlisted procedure, foot or toes), HCPCS S2117 (arthroereisis, subtalar) and ICD-10 procedure codes 0SUH0JZ, 0SUH3JZ, 0SUH4JZ, 0SUJ0JZ, 0SUJ3JZ and 0SUJ4JZ as investigational codes.
03Federal Employee Program (FEP) plans may dictate that FDA-approved devices are assessed only on the basis of their medical necessity rather than as investigational.
Codes mentioned
28899S2117
Original notice
Subtalar Arthroereisis
bcbsms.com · Always check the source before changing claims.