CurrentCignaPolicy 0446

Metatarsophalangeal Joint Replacement

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Coverage for partial or total first metatarsophalangeal joint replacement for severe disabling symptoms caused by hallux valgus or hallux rigidus with degenerative joint disease, subject to applicable benefit plans and coverage criteria.

Policy Summary

PayerCigna

PolicyMetatarsophalangeal Joint Replacement

Policy CodePolicy 0446

Change TypeAnnual reviewno material change

Effective DateOct 15, 2026

Next Review DateOct 15, 2027

Key ActionDocument qualifying first-MTP disease, severe disabling symptoms, and failed conservative management before requesting replacement.

SourceLink

POLICY UPDATE CHANGES

The 2026 annual review documents no clinical policy statement changes.

2Covered clinical indications

2Required medical-necessity conditions

3Experimental implant categories

3Experimental replacement sites

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CurrentCignaPolicy 0446

Metatarsophalangeal Joint Replacement

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Get alerted when Policy 0446 changes without checking for updates manually.

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Policy Summary

PayerCigna

PolicyMetatarsophalangeal Joint Replacement

Policy CodePolicy 0446

Change TypeAnnual reviewno material change

Effective DateOct 15, 2026

Next Review DateOct 15, 2027

Key ActionDocument qualifying first-MTP disease, severe disabling symptoms, and failed conservative management before requesting replacement.

SourceLink

POLICY UPDATE CHANGES

The 2026 annual review documents no clinical policy statement changes.

2Covered clinical indications

2Required medical-necessity conditions

3Experimental implant categories

3Experimental replacement sites

Listed procedure and supply codes

Coverage Criteria

Partial or total first-MTP replacement

Covered when BOTH of the following criteria are met:

Required criteria

Qualifying symptoms and diagnosis: Persistent severe disabling symptoms from hallux valgus or hallux rigidus due to degenerative joint disease of the first metatarsophalangeal (MTP) joint.
Failure of conservative management: Failure of conservative medical management, such as adaptive footwear, nonsteroidal anti-inflammatory drugs (NSAIDs), or orthoses.

Experimental implant technologies

Considered experimental, investigational, or unproven when ANY of the following conditions applies:

Ceramic implant: Use of a ceramic implant, such as the Moje prosthesis, for partial or total replacement of the first MTP joint or any other foot joint.
Synthetic cartilage implant: Use of a synthetic cartilage implant, such as the Cartiva Synthetic Cartilage Implant, for partial or total replacement of the first MTP joint or any other foot joint.
Personalized 3D-printed implant: Use of a personalized, customized, patient-specific 3D-printed implant for partial or total replacement of the first MTP joint or any other foot joint.

Replacement of non-first-MTP joints

The following joint-replacement procedures are considered experimental, investigational, or unproven:

Non-first-MTP joint replacement sites

Other MTP joint: MTP joint replacement for a joint other than the first MTP joint.
Other toe joint: Replacement of any other toe joint, such as an interphalangeal joint.
Tarsometatarsal joint: Replacement of a tarsometatarsal (TMT) joint.

Ceramic implants (such as the Moje prosthesis), synthetic cartilage implants (such as the Cartiva Synthetic Cartilage Implant), and personalized, customized, patient-specific 3D-printed implants used for partial or total replacement of the first metatarsophalangeal (MTP) joint or any other foot joint are considered experimental, investigational, or unproven.

Replacement involving a joint other than the first MTP joint is considered experimental, investigational, or unproven. This includes replacement of another MTP joint, any other toe joint such as an interphalangeal joint, or a tarsometatarsal (TMT) joint.

Coding Information

Considered Medically Necessary CPT CodesCPTCovered

28291

Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant

Considered Medically Necessary HCPCS CodesHCPCSCovered

L8641	Metatarsal joint implant
L8642	Hallux implant

Considered Experimental/Investigational/Unproven CPT CodesCPTExperimental

28899

Unlisted procedure, foot or toes

Considered Experimental/Investigational/Unproven HCPCS CodesHCPCSExperimental

L8699

Prosthetic implant, not otherwise specified

Provider and Billing Actions

Step Therapy

Conservative Management Before Replacement

Before requesting first-MTP replacement, document failure of conservative medical management. Replacement is covered as an alternative to arthrodesis only after appropriate nonsurgical treatment has failed.

Examples include adaptive footwear, nonsteroidal anti-inflammatory drugs (NSAIDs), and orthoses.

Documentation Required

Document First-MTP Medical Necessity

Support first-MTP replacement requests with documentation that establishes the qualifying diagnosis, severity, degenerative disease, and prior treatment. The record must show both required medical-necessity criteria.

Persistent severe disabling symptoms from hallux valgus or hallux rigidus.
Degenerative joint disease of the first metatarsophalangeal (MTP) joint.
Failure of conservative medical management, such as adaptive footwear, NSAIDs, or orthoses.

Clinical Background

Hallux valgus is a deformity of the great toe that may cause a prominence at the first metatarsal head, painful joint motion, and difficulty wearing footwear. Hallux rigidus is degenerative arthritis of the first MTP joint associated with pain, stiffness, reduced or lost range of motion, and progressive loss of great-toe mobility. In this policy, first-MTP replacement is considered as an alternative to arthrodesis for patients with persistent severe disabling symptoms from hallux valgus or hallux rigidus due to degenerative first-MTP joint disease, after failure of conservative medical management.

Definitions

Arthrodesis

MeaningSurgical fusion of a joint in which the joint surfaces are permanently joined to eliminate motion.

PurposeTypically performed to relieve pain and improve stability.

Common usesUsed in cases of severe arthritis, deformity, or joint destruction.

First metatarsophalangeal (MTP) joint

DefinitionThe joint formed by the head of the first metatarsal and the base of the proximal phalanx of the great toe.

LocationLocated at the base of the great toe, also called the hallux or big toe.

Full name

Policy Summary

PayerCigna

PolicyMetatarsophalangeal Joint Replacement

Policy CodePolicy 0446

Change TypeAnnual reviewno material change

Effective DateOct 15, 2026

Next Review DateOct 15, 2027

Key ActionDocument qualifying first-MTP disease, severe disabling symptoms, and failed conservative management before requesting replacement.

SourceLink

On This Page

Billing Rule

Use Covered Diagnoses and Procedure Codes

Submit claims with the most appropriate covered diagnosis and procedure codes in effect on the submission date. Services billed for noncovered conditions or without applicable covered codes may be denied as not covered.

Use a covered diagnosis consistent with hallux valgus or hallux rigidus due to degenerative joint disease of the first MTP joint.
Confirm that the submitted procedure is the covered partial or total first-MTP replacement procedure and that applicable coding requirements are met.

Denial Risk

Experimental Implant or Non-First-MTP Replacement

Expect denial as experimental, investigational, or unproven when the replacement uses an excluded implant category or involves a joint other than the first MTP joint.

Ceramic implants, including the Moje prosthesis.
Synthetic cartilage implants, including the Cartiva Synthetic Cartilage Implant.
Personalized, customized, or patient-specific 3D-printed implants.
MTP replacement for joints other than the first MTP joint, replacement of another toe joint such as an interphalangeal joint, or replacement of a tarsometatarsal (TMT) joint.

Denial Risk

Medical-Necessity Criteria Not Met

First-MTP replacement is medically necessary only when all policy criteria are satisfied. If either persistent severe disabling symptoms from qualifying degenerative disease or failure of conservative medical management is not documented, the request does not meet the policy criteria.

The procedure must be a partial or total replacement of the first MTP joint.
The replacement must be requested as an alternative to arthrodesis.
Both qualifying symptom/diagnosis and failed-conservative-treatment criteria are required.

First metatarsophalangeal joint.

Hallux valgus

DefinitionA deformity of the great toe characterized by lateral deviation of the hallux toward the lesser toes.

Associated findingOften associated with a prominence at the first metatarsal head, commonly called a bunion.

Affected digitThe hallux, or great toe.

Hallux rigidus

DefinitionA degenerative arthritic condition of the first MTP joint.

SymptomsCharacterized by pain, stiffness, and reduced range of motion.

ProgressionMay involve progressive loss of great-toe mobility.