CurrentKaiser PermanentePolicy N/A

Kaiser Permanente Clinical Review Criteria - Subtalar Arthroereisis

Defines Kaiser Permanente Clinical Review Criteria for subtalar arthroereisis (insertion/removal) for treatment of flexible flatfoot (pes planus) for Kaiser Foundation Health Plan of Washington members; distinguishes Medicare vs non-Medicare considerations and provides coverage decision and applicable procedure codes.

Policy Summary

PayerKaiser Permanente

PolicyKaiser Permanente Clinical Review Criteria - Subtalar Arthroereisis

Policy CodePolicy N/A

Change TypeClarified (no material change)

Effective Date

Next Review Date

Key ActionVerify a specific member's coverage via the patient's Evidence of Coverage or by calling Kaiser Permanente Member Services at 1-888-901-4636 (TTY 711), Monday–Friday, 8 am–5 pm.

SourceLink

POLICY UPDATE CHANGES

Policy states that subtalar arthroereisis does not meet Kaiser Permanente Medical Technology Assessment Criteria due to insufficient evidence.

1Coverage stance

4Procedure codes listed as not medically necessary

~20Articles identified (approx.)

Coverage Determination

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Policy stance: Not covered / Not medically necessary — subtalar arthroereisis (insertion or removal of sinus tarsi implant) is considered not medically necessary for treatment of flexible flatfoot (pes planus). Scope: These Clinical Review Criteria apply to Kaiser Foundation Health Plan of Washington members (and Kaiser Foundation Health Plan of Washington Options, Inc.). Medicare distinction: Medicare-specific considerations are noted separately in the policy (see Medicare foot care exclusions referenced in policy).

Medical-Necessity Rationale & Evidence

Arthroereisis involves placement of implants beneath the talus in the sinus tarsi to limit excessive eversion while preserving inversion; implants are intended to block forward, downward and medial displacement of the talus while allowing normal subtalar motion. The published evidence consists largely of small case series and cadaver studies; there are no randomized or controlled comparative trials demonstrating efficacy or safety.

Evidence item	Summary
Evidence conclusion (06/04/2007 MTAC review)	Insufficient published evidence to determine efficacy and safety of arthroereisis for flexible flatfeet in adults; published studies are small case series or cadaver studies with no comparison groups.
Largest case series sizes cited	Two largest case series reported 23 and 21 patients (Needleman 2006; Viladot 2003).
Coverage stance based on evidence	Subtalar arthroereisis does not meet Kaiser Permanente Medical Technology Assessment Criteria and is considered not medically necessary for pes planus treatment.
Procedure codes listed	Codes considered not medically necessary: 0335T (insertion of sinus tarsi implant), S2117 (arthroereisis, subtalar), 0510T (removal of sinus tarsi implant), 0511T (removal and reinsertion of sinus tarsi implant).

Actions for Providers

Documentation Required

Consult Evidence of Coverage for member-specific benefits

Verify the individual member's benefits before proceeding. Check the patient's Evidence of Coverage (EOC) or call Kaiser Permanente Member Services at 1-888-901-4636 (TTY 711), Monday–Friday, 8 am–5 pm to determine coverage for a specific medical service.

Prior Authorization

Pre-authorization code check advised

Use the Pre-authorization Code Check to confirm whether a specific procedure code requires prior authorization for the member's plan type.

Note to providers: The procedure codes listed in this policy (e.g., 0335T, S2117, 0510T, 0511T) are designated as Considered Not Medically Necessary under this policy and authorization requests for these codes may be denied consistent with the coverage determination.

Definitions & Background

Medicare reference: The policy notes the Medicare-related reference to Foot care exclusions from MBPM Chapter 15; no specific National Coverage Determination (NCD) number is provided.

Flexible flatfoot (collapsing pes valgo planus): A deformity with plantar medial rotation of the talus, decreased medial arch height, and forefoot abduction; flexible indicates the deformity is correctable.

Medicare Considerations

Clinical background: Flexible flatfoot is commonly managed with functional orthoses, though severe deformities may require surgical reconstruction. Arthroereisis was developed to be used in combination with other bone and soft-tissue procedures; however, the evidence base consists mainly of small case series and cadaver studies with no controlled trials to compare outcomes to alternative therapies.

Revision History

06/04/2007evidence_review

MTAC review concluded there is insufficient published evidence to determine efficacy and safety of subtalar arthroereisis for flexible flatfeet in adults; studies were small case series or cadaver studies with no controlled trials; use does not meet Kaiser Permanente Medical Technology Assessment Criteria.

06/26/2007policy_creation

Policy created listing subtalar arthroereisis procedure codes considered not medically necessary (e.g., 0335T, S2117, 0510T, 0511T).

04/06/2011review