Anthem Blue Cross Connecticut SURG.00104 Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis Form

This document addresses the use of extraosseous subtalar joint implantation and subtalar arthroereisis.

Extraosseous subtalar joint implantation is a minimally invasive surgical procedure performed to stabilize and prevent redislocation of the talotarsal joint for symptoms associated with hyperpronation caused by partial talotarsal joint dislocation or talotarsal joint instability.

Subtalar arthroereisis is a surgical procedure performed to correct excessive talar displacement and calcaneal eversion due to pes planus (flatfoot) by placement of an implant in the sinus tarsi. Subtalar arthroereisis may be performed alone or in combination with other comprehensive surgical procedures for ankle and foot conditions.

Note: Please see the following related document for additional information:

• CG-DME-22 Ankle-Foot & Knee-Ankle-Foot Orthoses

Position Statement

Investigational and Not Medically Necessary:

1. Subtalar arthroereisis is considered investigational and not medically necessary for all indications, including but not limited to the treatment of flatfoot conditions, symptomatic flexible flatfoot deformity, and posterior tibial tendon dysfunction.
2. Extraosseous subtalar joint implantation is considered investigational and not medically necessary for all indications, including but not limited to, talotarsal joint stabilization.