Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · OrthopedicsMedium impact
Total Ankle Replacement
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Total ankle replacement using an FDA-approved device may be considered medically necessary in skeletally mature patients with moderate to severe ankle (tibiotalar) pain that limits daily activity and who have arthritis in adjacent joints (subtalar or midfoot), severe arthritis or arthrodesis of the contralateral ankle, or inflammatory (e.g., rheumatoid) arthritis. Total ankle replacement is considered investigational for all other indications. Absolute contraindications include extensive avascular necrosis of the talar dome, compromised bone stock or soft tissue, severe malalignment (e.g., >15 degrees) not correctable by surgery, active ankle joint infection, peripheral vascular disease, and Charcot neuroarthropathy.
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01Billing team: Before billing CPT 27702, 27703 or 01486 for total ankle replacement, confirm the patient is skeletally mature and has moderate to severe ankle pain that limits daily activity, plus one of the listed conditions.
02The procedure must use an FDA-approved device to be considered medically necessary.
03Claims need documentation that supports medical necessity, because BCBSMS makes no payment for services not documented to be medically necessary.
04Patients with bilateral or subtalar arthritis or Chopart arthrosis are listed as not optimal candidates.
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