← Back to list
Hammertoe Repair (CPB 0636, reviewed 2026-09-11)
Effective date
Not stated in the notice
Identified
Oct 3, 2026
Summary
Aetna's Clinical Policy Bulletin 0636 sets out the criteria it uses to consider hammertoe repair medically necessary, including radiographs, proof of skeletal maturity, and at least 3 months of documented conservative treatment with persistent pain and difficulty walking, plus one of the listed indications. It treats the named fixation implants, plantar plate repair, and hammertoe repair that does not meet the criteria as experimental. The source shows a review date of 2026-09-11 but states no effective date, so treat it as historical material and confirm current applicability.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.
Get Aetna alertsPolicy Monitoring is free. No card required.
What to do
Action · 5 steps
01No effective date is stated, so this is historical material: confirm current applicability on Aetna's website before acting on it.
02If it still applies, Billing team: before booking hammertoe repair (28285, 28286), confirm the chart has radiographic confirmation with anterior/posterior and lateral views of the foot and a report, documentation of skeletal maturity, and documentation of persistent pain and difficulty walking after at least 3 months of conservative care.
03Providers and front desk staff: document one of the listed indications (for example adventitious bursitis, DIP or PIP ankylosis, interdigital neuroma, or ulceration of the apices) and collect the records before scheduling surgery.
04Billing team: in charge entry, do not bill the named fixation implants or plantar plate repair as covered services, and expect claims for these to be treated as experimental; the source lists CrossTie, ToeTac Xpress, CannuLink and L8641 as not covered with no specific code.
05Repeat surgery after a failed prior procedure is listed as medically necessary.
Codes mentioned
282852828611044110477362073630L8641J0702J0834J1020J1030J1040J1094J1100J1700J1710J1720J2650J2920J2930J3300J3301J3302J3303L3000L3030E64.3G57.60G57.63L97.501L97.529M12.271M12.279M20.40M20.42M20.62M24.571M24.576M24.671M24.676M65.871M65.879M67.00M67.02M77.50M77.52M77.9Q66.7Q74.2S93.141AS93.149S
Original notice
Hammertoe Repair (CPB 0636, reviewed 2026-09-11)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Hammertoe Repair (CPB 0636, reviewed 2025-12-11)LowNo effective date · Medical PolicyGuillain-Barre Syndrome Treatments (CPB 0732, reviewed 2026-10-21)MediumNo effective date · Medical PolicyGuillain-Barre Syndrome Treatments (CPB 0732, reviewed 2025-12-19)MediumNo effective date · Medical PolicyCarbon Dioxide Laser (CPB 0427, reviewed 2026-07-08)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesOrthopedicsPodiatryCode 28285Code 28286Code 11044Code 11047Code 73620Code 73630Code L8641Code J0702Code J0834Code J1020Code J1030Code J1040Code J1094Code J1100Code J1700Code J1710Code J1720Code J2650Code J2920Code J2930Code J3300Code J3301Code J3302Code J3303Code L3000Code L3030Code E64.3Code G57.60Code G57.63Code L97.501Code L97.529Code M12.271Code M12.279Code M20.40Code M20.42Code M20.62Code M24.571Code M24.576Code M24.671Code M24.676Code M65.871Code M65.879Code M67.00Code M67.02Code M77.50Code M77.52Code M77.9Code Q66.7Code Q74.2Code S93.141ACode S93.149S