UnitedHealthcare’s March 1, 2026 revision to MDC 08 (Orthopedics & Musculoskeletal) classifies radiostereometric analysis (RSA) codes (0347T–0350T), subtalar sinus tarsi/arthroereisis codes (0335T, 0510T, 0511T, S2117), and humeral lengthening with externally controlled intramedullary devices (0594T) as unproven and not medically necessary due to insufficient evidence of safety and/or efficacy. RSA is acknowledged as a precise research tool but lacks data showing routine clinical benefit versus standard imaging. Sinus tarsi implants show heterogeneous, low-quality evidence with variable complication and removal rates, and are not supported for any indication. Humeral lengthening procedures have limited case-series data with substantial complication rates, and comparative benefit over other techniques remains unestablished.
March 2026 Revision: Specific Unproven Determinations for RSA, Sinus Tarsi Implants, and Humeral Lengthening
This UnitedHealthcare Medical Policy (MDC 08: Orthopedics & Musculoskeletal) effective 2026-03-01 lists specific additions and determinations for several procedures and CPT/HCPCS codes. Key explicit conclusions in this revision state that the following are considered "Unproven" and "not medically necessary due to insufficient evidence of safety and/or efficacy":
- Radiostereometric analysis (
0347T,0348T,0349T,0350T) and placement of interstitial markers for RSA. - Subtalar sinus tarsi implant procedures including insertion (
0335T), removal (0510T), removal and reinsertion (0511T), and the omnibus arthroereisis code (S2117). - Osteotomy with insertion of an externally controlled intramedullary humeral lengthening device (
0594T) and humeral lengthening procedures (intramedullary or external) are characterized as unproven/not medically necessary for humeral lengthening indications.
The revision also reiterates other code-specific determinations across the policy document (e.g., various unrelated CPT codes listed as "Unproven" elsewhere), but the orthopedic-focused determinations above are prominently documented in the Orthopedics & Musculoskeletal sections of the policy.
Radiostereometric Analysis (`0347T`–`0350T`): Research Utility but Classified as Unproven for Clinical Use
The policy states that radiostereometric analysis (RSA) — including the placement of interstitial bone markers (0347T) and RSA imaging for spine (0348T), upper extremity (0349T), and lower extremity (0350T) — is "unproven and not medically necessary for all indications." The document frames RSA as a precise research tool used to measure micromotion of implants and fracture healing, but emphasizes there is insufficient evidence that routine clinical use improves health outcomes compared with conventional imaging. The policy cites limitations such as need for tantalum marker implantation, specialized imaging and software, and a lack of large randomized trials comparing RSA to other modalities.
Several cited studies and reviews (e.g., precision/accuracy reviews, long-term RSA follow-ups, and applications to fracture healing) are acknowledged in evidence summaries. While RSA is recognized as useful in orthopedic research and phased introduction of implants, the policy concludes that available data do not yet support clinical coverage for routine indications.
Subtalar Arthroereisis / Sinus Tarsi Implants (`0335T`, `0510T`, `0511T`, `S2117`): Evidence Heterogeneity and Unproven Status
Subtalar arthroereisis (use of sinus tarsi implants and related procedure codes 0335T, 0510T, 0511T, S2117) is explicitly described as "unproven and not medically necessary for any indication due to insufficient clinical evidence of safety and/or efficacy." The policy summarizes pediatric and adult literature including multiple systematic reviews, single-center studies, and health technology assessments (e.g., CAHT, Hayes, ECRI, NICE) showing heterogeneous and low-quality evidence.
Evidence discussed includes mixed radiographic and patient-reported improvements in symptomatic flexible pes planus, variable complication and implant removal rates (reported as 0% up to ~48% across studies), and common adverse events such as sinus tarsi pain prompting device removal. Professional guidance (American College of Foot and Ankle Surgeons) and regulatory/health technology assessments are cited to support the conclusion that current evidence is inadequate to establish safety and effectiveness for routine use.
Humeral Lengthening and `0594T`: Limited Data, High Complication Rates, and Unproven Classification
Humeral lengthening procedures involving intramedullary or externally controlled lengthening devices (notably 0594T for osteotomy with an externally controlled intramedullary lengthening device) are characterized as "unproven and not medically necessary due to insufficient evidence of efficacy." The policy summarizes limited and low-quality evidence: single-center series and small systematic reviews report functional gains in selected patients but also substantial complication rates.
For example, a retrospective single-center report of bilateral humeral lengthening using monolateral external fixators reported that most patients achieved target length but 50% experienced significant complications (including radial nerve palsy, unplanned reoperations, and refracture); systematic reviews of motorized intramedullary nails describe favorable outcomes but with very small case counts. The policy references NICE interventional guidance noting limited evidence but allowing use with special governance, and ECRI/HTA findings that evidence is inconclusive and comparative benefits versus external fixation remain uncertain.
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