Subtalar Arthroereisis
Customize your policy alerts
Sign up for Blue Cross Blue Shield - Iowa Policy 07.01.34 alerts
Get alerted when Policy 07.01.34 changes without checking for updates manually.
Monitor payer policy activity
Wellmark Blue Cross and Blue Shield Iowa evidence review and policy determining coverage status for subtalar arthroereisis/extra‑osseous subtalar joint implants (sinus tarsi implants) for all indications; excludes subtalar arthrodesis (fusion). Policy addresses investigational determination, evidence summary, coding, and NA prior authorization.
Policy renewed at July 2025 annual review; policy was revised in June 2023 and previously revised multiple times.
Coverage Summary
Wellmark Blue Cross and Blue Shield policy 07.01.34 addresses subtalar arthroereisis (sinus tarsi implants) and determines the procedure is investigational for all indications. The policy excludes subtalar arthrodesis (fusion) from its scope. Effective date: 2006-12-01; last review: 2025-07-01.
Coverage status: Investigational for all indications. Regulatory status: multiple sinus tarsi implants have been cleared via FDA 510(k). Evidence strength: overall limited — principally single-arm studies, systematic reviews of observational data, and a small nonrandomized comparative trial, with methodological limitations and insufficient long-term data. Reported adverse events and implant removal rates vary widely across series, with unplanned removal and complication rates reported from low single digits up to approximately ~46% in some reports.
Policy Medical Necessity Determination
Policy coverage statement
Policy determination:
ALL of the following
- Subtalar arthroereisis/extra-osseous subtalar joint implant is considered investigational for all indications because the evidence is insufficient to determine the technology results in an improvement in net health outcomes.
- This evidence review addresses subtalar arthroereisis (implant in the sinus tarsi). Subtalar arthrodesis (joint fusion) is not addressed in this policy.
Provider Actions & Billing
Prior approval
Prior approval: Not applicable (policy states 'Prior Approval Not applicable').
Benefit verification and medical necessity
Verify individual member benefits and contract exclusions; Wellmark determines medical necessity only if the benefit exists and no contract exclusions apply.
- Verify member benefits and contract exclusions prior to services.
CPT / HCPCS Codes
Background & Evidence Summary
Subtalar arthroereisis places an implant into the sinus tarsi (canal between the talus and calcaneus) to limit subtalar joint pronation and correct talar displacement and calcaneal eversion. Multiple implant designs have been used for >50 years (for example, the Maxwell‑Brancheau implant, HyProCure, Kalix, subtalar peg), and devices vary in composition and insertion technique. The procedure is sometimes performed as a stand‑alone operation but frequently is combined with adjunctive bone or soft‑tissue procedures, and reported outcomes vary across studies and device types.
| Study / Source | Key findings |
|---|---|
| Systematic review (Galan-Olleros 2024) | |
| Improved pain in 93.5% (95% CI 89–97.99); heel valgus correction 95.21% (95% CI 91.14–99.28); overall complications 7.8% (Calcaneo-stop pooled; 20 studies, N=2394 feet) | |
| Nonrandomized comparative trial (Chong 2015) | |
| Prospective N=24 feet comparing arthroereisis vs lateral column lengthening: no between-group differences in clinical or functional outcomes at ~12.7 months; small sample, preliminary; 2 complications per group with some implant removals | |
| Prospective single-arm (Bresnahan 2013) | |
| HyProCure in talotarsal dislocation (46 feet): Maryland Foot Score improved from 69.53 to 89.17 at 1 year; foot pain decreased 37.0%; implants removed from 2 feet | |
| Safety signal | |
| Reports of implant reactions, sinus tarsi pain, implant migration, under/overcorrection, and implant removal; complication rates vary across series (examples: overall complications 7.8% in pooled Calcaneo-stop; other series report explantation/removal rates from ~7–39% and occasional rates up to 46%) | |
| Health technology assessments | |
| Hayes HTA (2020, updated 2023) rated evidence insufficient (D2) for adult-acquired flatfoot; pediatric HTA rated overall current evidence very low |
Subtalar arthroereisis: Surgical procedure placing an implant in the sinus tarsi to limit subtalar joint motion and reduce excessive pronation; also called extraosseous talotarsal stabilization.
Talotarsal joint dislocation: Abnormal alignment of the talus with the heel and/or navicular bones.
Not Covered / Investigational
Policy determination: subtalar arthroereisis/extra‑osseous subtalar joint implants (sinus tarsi implants) are considered investigational for all indications because the evidence is insufficient to demonstrate an improvement in net health outcomes. Consequently, these implants are not covered. This policy explicitly does not address subtalar arthrodesis (joint fusion), which is excluded from this policy.
Revision History
Policy renewed at July 2025 annual review; policy was revised in June 2023 and previously revised multiple times.
Policy was revised in June 2023; prior revisions occurred in multiple prior years as listed in policy history.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.