CurrentBlue Cross Blue Shield - MassachusettsPolicy 299

Subtalar arthroereisis (sinus tarsi implant / extraosseous talotarsal stabilization) coverage

This policy governs coverage and prior authorization requirements for subtalar arthroereisis (sinus tarsi implant / extraosseous talotarsal stabilization) for Blue Cross Blue Shield Massachusetts members across commercial and Medicare products.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicySubtalar arthroereisis (sinus tarsi implant / extraosseous talotarsal stabilization) coverage

Policy CodePolicy 299

Change TypeNo material change

Effective Date

Next Review DateJun 1, 2025

Key ActionObtain precertification/preauthorization for inpatient subtalar arthroereisis; outpatient subtalar arthroereisis is not a covered service for multiple product lines.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

InvestigationalPolicy stance

S2117Investigational HCPCS

Prior auth requiredAuthorization

Not coveredOutpatient coverage

InsufficientEvidence

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Coverage Determinations and Evidence Summary

Investigational / Not covered with authorization notes

Covered when ALL of the following are met:

Policy stance: Subtalar arthroereisis is considered investigational.

Applies to Commercial and Medicare products referenced in the policy.

Evidence summary: Available evidence (single-arm observational studies, systematic reviews of observational data, and a small nonrandomized trial) is insufficient to demonstrate improvement in net health outcome due to limitations including adjunctive procedures, short-term follow-up in growing children, small sample sizes, and reported high rates of complications and implant removal.

Specific use for talotarsal joint dislocation likewise has insufficient evidence.

Authorization requirement: Precertification/preauthorization is required for inpatient services; outpatient subtalar arthroereisis is listed as not a covered service for multiple product lines (Commercial Managed Care HMO and POS; Commercial PPO and Indemnity; Medicare HMO BlueSM; Medicare PPO BlueSM).

Providers should follow product-specific coverage and precertification rules; failure to obtain required precertification or billing outpatient when not covered may result in claim denial.

Outpatient subtalar arthroereisis is not a covered service for the following product lines: Commercial Managed Care (HMO and POS), Commercial PPO and Indemnity, Medicare HMO BlueSM, and Medicare PPO BlueSM. Precertification/preauthorization is required when the procedure is performed as an inpatient service.

The policy concludes that subtalar arthroereisis is investigational because available evidence is insufficient to demonstrate an improvement in net health outcome. The body of evidence includes single-arm observational studies, systematic reviews of observational data, and a small nonrandomized comparative trial; limitations cited include adjunctive procedures that confound attribution of benefit, short-term follow-up (particularly important in growing children), and reported high rates of complications and implant removal. For talotarsal joint dislocation, current evidence is likewise insufficient to draw definitive conclusions about efficacy.

Codes and Billing Status

Investigational HCPCS CodesHCPCSNot Covered

S2117

Arthroereisis, subtalar

Informational coding guidancemixed

No codes listed

Precertification, Reporting, and Provider Guidance

Prior Authorization

Prior Authorization Required

Precertification/preauthorization is required for inpatient services described in this policy. Outpatient services described in this policy are not covered for multiple product lines (see items). Providers must obtain precertification before inpatient admission to avoid claim denials or payment delays.

Inpatient: Precertification/preauthorization required for all products when the procedure is performed inpatient.
Outpatient: Not a covered service for the following product lines - Commercial Managed Care (HMO and POS); Commercial PPO and Indemnity; Medicare HMO; Medicare PPO.

Documentation Required

Provider Instructions

Obtain and document precertification approval number in the medical record and on claims. For inpatient admissions, include clinical documentation that supports medical necessity per plan criteria.

Clinical Context

Subtalar arthroereisis (also described as a sinus tarsi implant or extraosseous talotarsal stabilization) is a surgical procedure that places an implant in the sinus tarsi — a canal between the talus and calcaneus — to limit excessive pronation of the subtalar joint and correct talar displacement and calcaneal eversion. Device designs (for example, HyProCure and others) and the procedure have been used in children and adults, and have been studied both alone and with adjunctive bone or soft-tissue procedures.

Key Terms

Subtalar arthroereisis — definition / alternate names

TermSubtalar arthroereisis (also called extraosseous talotarsal stabilization)

Procedure descriptionSurgical placement of an implant in the sinus tarsi to limit excessive subtalar joint pronation and correct talar displacement and calcaneal eversion.

Common device examplesMaxwell-Brancheau implant (most frequently reported); other devices include HyProCure, subtalar arthroereisis peg, and Kalix.

Typical use casesUsed to treat symptomatic flatfoot (often in children and adults) and being evaluated for talotarsal joint dislocation.

Surgical considerationsMay be performed as a stand-alone procedure in children but is often combined with adjunctive bone or soft-tissue procedures; implant is reversible and does not require bone cement (Maxwell-Brancheau).