CurrentBlue Cross Blue Shield - MassachusettsPolicy 299

Subtalar Arthroereisis (Sinus Tarsi Implants / Extraosseous Talotarsal Stabilization)

Policy governs coverage and authorization requirements for subtalar arthroereisis (sinus tarsi implants/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 Implants / Extraosseous Talotarsal Stabilization)

Policy CodePolicy 299

Change TypeNo material clinical or coverage changes

Effective Date

Next Review DateJun 1, 2026

Key ActionObtain precertification/preauthorization for any inpatient subtalar arthroereisis procedures.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

INVESTIGATIONALStance

S2117Investigational code

Precert requiredInpatient auth

Not coveredOutpatient

Through 2026Review cycle

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Coverage Determinations

Investigational / Not covered

Covered when ALL of the following are met:

Policy position: Subtalar arthroereisis is investigational for the indication(s) described and therefore not covered for Commercial and Medicare products as stated; evidence is insufficient to demonstrate improved net health outcome.

Supported by single-arm observational studies, systematic reviews of observational data, and a small nonrandomized controlled trial with limitations including adjunctive procedures, limited long-term outcomes, and reports of high complication and implant removal rates.

Outpatient subtalar arthroereisis is not a covered service for Commercial Managed Care (HMO and POS), Commercial PPO and Indemnity, Medicare HMO Blue SM, and Medicare PPO Blue SM. Claims for outpatient procedures may be denied for lack of coverage when performed in the outpatient setting.

Subtalar arthroereisis is designated investigational because the available evidence is insufficient to demonstrate improved net health outcomes. Published data are primarily single-arm observational studies, systematic reviews of observational data, and a small nonrandomized comparative trial; limitations include adjunctive procedures that confound attribution of benefit, limited long-term outcome data (important when performed in growing children), and reports of high complication and implant removal rates. Therefore, the evidence does not reliably establish clinical benefit for flatfoot or talotarsal joint dislocation.

Billing and Coding

Investigational HCPCS CodesHCPCSNot Covered

S2117

Arthroereisis, subtalar

Provider Requirements and Notices

Prior Authorization

Inpatient prior authorization required

For services described in this policy, precertification/preauthorization is required when the procedure is performed inpatient. Contact the member's plan for inpatient authorization requirements and submit supporting clinical documentation per plan procedures.

Applies to all products when performed inpatient.
Precertification/preauthorization must be obtained before admission to avoid claim denials.

Note

Provider action — verify authorization

Providers should verify authorization requirements and plan-specific submission instructions prior to scheduling procedures. When inpatient authorization is required, include the anticipated procedure code, diagnosis, and clinical rationale on the request.

Check member benefits and inpatient authorization phone/web portal for plan-specific rules.
Failure to obtain required inpatient authorization may result in denial or reduced payment.

Clinical Background

Subtalar arthroereisis, also called extraosseous talotarsal stabilization, is a surgical procedure that limits movement across the subtalar joint by placing an implant in the sinus tarsi — a canal between the talus and calcaneus. The procedure is intended to reduce pronation across the subtalar joint, correcting excessive talar displacement and calcaneal eversion, and is used to treat symptomatic flatfoot and to address talotarsal joint dislocation. It has been performed with a variety of implant designs and may be used alone or with adjunctive bone or soft-tissue procedures, particularly in pediatric patients.

Definitions

Subtalar arthroereisis / extraosseous talotarsal stabilization — definition and mechanism

TermSubtalar arthroereisis / extraosseous talotarsal stabilization

DefinitionSurgical placement of an implant in the sinus tarsi (canal between the talus and calcaneus) to limit movement across the subtalar joint and reduce talar displacement and calcaneal eversion.

Intended effect / mechanismLimits subtalar joint pronation by reducing motion across the joint, correcting excessive talar displacement and calcaneal eversion.

Common devicesExamples reported in the literature include Maxwell-Brancheau Arthroereisis, HyProCure, subtalar arthroereisis peg, and Kalix.

Use considerationsMay be performed as a stand-alone procedure (often in children) or combined with adjunctive bone or soft-tissue procedures to correct additional deformities.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicySubtalar Arthroereisis (Sinus Tarsi Implants / Extraosseous Talotarsal Stabilization)

Policy CodePolicy 299

Change TypeNo material clinical or coverage changes

Effective Date

Next Review DateJun 1, 2026

Key ActionObtain precertification/preauthorization for any inpatient subtalar arthroereisis procedures.

SourceLink

On This Page

Documentation Required

Coding and documentation guidance

Report services using current industry-standard procedure, revenue, and diagnosis codes; include applicable modifiers. Maintain complete clinical documentation to support medical necessity and the setting of service.

Use the most up-to-date CPT/HCPCS and ICD-10 codes.
Include modifiers where applicable and append supporting clinical notes.
Retain operative reports, imaging, and clinical notes to justify inpatient setting if requested.

Denial Risk

Outpatient subtalar arthroereisis not covered

Subtalar arthroereisis is not a covered outpatient service for Commercial Managed Care (HMO and POS), Commercial PPO and Indemnity, Medicare HMO Blue SM, and Medicare PPO Blue SM. Do not submit outpatient claims expecting coverage; prior authorization will not change noncovered status.

Outpatient = not a covered service for listed products.
Submit for inpatient only where authorization requirements apply.

Billing Rule

Investigational coding note

HCPCS code S2117 (Arthroereisis, subtalar) is considered investigational for Commercial and Medicare products and may trigger precertification review or denial. Ensure clinical requests explicitly address investigational status and provide strong supporting evidence if seeking consideration.

HCPCS S2117 — Arthroereisis, subtalar (investigational).
Investigational coding may prompt denial or require additional documentation during prior authorization review.