Subtalar Arthroereisis

Policy ID: S-194-015

Section: Surgery

Effective Date: July 01, 2018

Revised Date: December 01, 2021

Revision Effective Date: November 04, 2024

Last Reviewed: September 17, 2024

Applies To: Commercial and Medicaid Expansion

Description

Subtalar arthroereisis is a treatment of adult or pediatric flatfoot which involves the insertion of an implant into the sinus tarsi, that acts as an internal orthotic or spacer. Placement of the implant restores the arch of the foot while preventing excessive pronation.

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date.

Criteria

Subtalar arthroereisis for the treatment of adult or pediatric flatfoot conditions is considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer review literature.

Procedure Codes

0335T

0510T

0511T

S2117

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 1-22-2020 Coding update

Internal Medical Policy Committee 11-19-2020 Consent policy- no changes

Internal Medical Policy Committee 11-23-2021 Coding update - Effective January 01, 2022

Added procedure code 0335T.

Internal Medical Policy Committee 11-29-2022 Annual Review-no changes in criteria

Internal Medical Policy Committee 9-12-2023 Annual Review-no changes in criteria

Internal Medical Policy Committee 9-17-2024 Annual Review-no changes in criteria

Added Policy Application

Links

References (PDF)

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.

Policy ID: S-194-015

Section: Surgery

Effective Date: July 01, 2018

Revised Date: December 01, 2021

Revision Effective Date: January 01, 2022

Last Reviewed: September 12, 2023

Archived Date: November 03, 2024

Applies To: Commercial and Medicaid Expansion

Description

Criteria

Procedure Codes

0335T

0510T

0511T

S2117

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 1-22-2020 Coding update

Internal Medical Policy Committee 11-19-2020 Consent policy- no changes

Internal Medical Policy Committee 11-23-2021 Coding update - Effective January 01, 2022

Added procedure code 0335T.

Internal Medical Policy Committee 11-29-2022 Annual Review-no changes in criteria

Internal Medical Policy Committee 9-12-2023 Annual Review-no changes in criteria

Links

References (PDF)

Disclaimer

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