CurrentCapital BluecrossPolicy MP 1.114

SUBTALAR ARTHROEREISIS

This medical policy governs coverage for subtalar arthroereisis procedures and related implants for Capital BlueCross products to which the policy applies.

Policy Summary

PayerCapital Bluecross

PolicySubtalar arthroereisis

Policy CodePolicy MP 1.114

Change TypeNo material change

Effective DateAug 1, 2025

Next Review Date

Key ActionVerify member benefits and eligibility prior to service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

InvestigationalPolicy stance

5Not covered codes

Small trialKey evidence

Multiple 510(k)Regulatory status

8/1/2025Effective

Coverage Determination

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Investigational / Not Medically Necessary

Covered when ALL of the following are met:

Policy stance: Subtalar arthroereisis is considered investigational due to insufficient evidence to support a general conclusion about health outcomes or benefits.

Applies to the procedures and implants described in the policy.

The following procedure codes are designated investigational and not covered under this policy: S2117, 0335T, 0510T, 0511T, and 28899.

The evidence is insufficient to determine that subtalar arthroereisis results in an improvement in the net health outcome. Available studies are primarily single-arm case series and a small nonrandomized comparative trial (n=24 feet); limitations include adjunctive procedures in many reports, lack of long-term outcomes—particularly important for growing children—and reports of high complication and implant removal rates. Therefore, subtalar arthroereisis is considered investigational.

Procedure and Billing Codes

Investigational; therefore, not covered Procedure CodesCPTNot Covered

S2117	Investigational; therefore, not covered (procedure code listed in policy)
0335T	Investigational; therefore, not covered (procedure code listed in policy)
0510T	Investigational; therefore, not covered (procedure code listed in policy)
0511T	Investigational; therefore, not covered (procedure code listed in policy)
28899	Investigational; therefore, not covered (unlisted procedure code)

Provider Billing & Authorization Guidance

Prior Authorization

Investigational — Not Covered

Prior authorization is not applicable for investigational procedures. The listed procedure codes are not covered and prior authorization will not make them covered.

Investigational procedures are not eligible for prior authorization
Claims submitted with the listed codes may be denied

Note

Benefit Verification

Provider note: verify member benefits and eligibility prior to claim submission. Final claim payment is subject to the member's benefit program, eligibility on the date of service, and medical necessity determinations.

Benefit verification required — final claim processing depends on member benefit program and eligibility

Denial Risk

Investigational Procedures — Denial Risk

The following procedure codes are considered investigational and are not covered. Claims billed with these codes may be denied.

S2117
0335T
0510T
0511T
28899

Note

Provider action: confirm coding and do not submit prior authorization requests for the investigational codes listed above. If there is uncertainty about coverage for a specific member, contact Provider Services or Member Services for assistance.

Clinical Background

Subtalar arthroereisis (STA) has been performed for more than 50 years using a variety of implant designs and compositions. Implants are intended for insertion into the sinus tarsi to limit excessive pronation while permitting normal subtalar motion. The procedure is used in both children and adults and is frequently performed alongside adjunctive bone or soft‑tissue procedures, which complicates interpretation of outcomes attributable solely to STA. Long‑term outcomes—especially in growing children—are not well established, and some studies have reported relatively high rates of complications and implant removal.

Definitions and Anatomic Terms

Subtalar implant / arthroereisis device - definition and key facts

DefinitionDevices indicated for insertion into the sinus tarsi allowing normal subtalar joint motion while blocking excessive pronation.

Purpose/MechanismInserted into the sinus tarsi to limit excessive pronation while permitting normal subtalar motion.

Common implant examplesMaxwell-Brancheau, HyProCure, subtalar arthroereisis peg, Kalix (representative devices cleared by FDA).

Clinical useUsed in children and adults; in children may be offered as a stand‑alone procedure but often combined with adjunctive bone or soft‑tissue procedures to correct deformities.

Anatomic terms - calcaneus, talus

CalcaneusThe largest of the tarsal bones situated at the lower and back part of the foot forming the heel.

TalusThe ankle bone; the bone of the tarsus which articulates with the tibia at the ankle.

Anatomic relationshipThe talus articulates superiorly with the tibia and sits above the calcaneus, forming the ankle and subtalar articulations.