Medicare AdvantageCoverageHigh impact
Foot Surgical Procedures - Medicare Advantage (Revised)
Humana·Podiatry, Orthopedics·Medicare Advantage
Effective date
Sep 2, 2025
We identified it
Jun 24, 2026
Summary
This is a comprehensive Medicare Advantage policy update for foot surgical procedures including bunion correction, hallux rigidus/limitus treatment, and lesser toe deformities. The policy establishes specific medical necessity criteria requiring radiographic evidence and documented failure of conservative treatment before surgical intervention is covered.
Action Required
Before September 2, 2025: Billing team must update documentation requirements for foot surgical procedures to ensure radiographic evidence is documented and conservative treatment failure is clearly noted in medical records. Providers must document specific criteria including limited/painful range of motion, palpation pain at MTP joint, or development of neuromas. Update pre-authorization checklists to include these requirements as claims may be denied without proper documentation.