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DESCRIPTIONFlexible flatfoot is a common disorder, anatomically described as excessive pronation during weight bearing due to anterior and medial displacement of the talus. It may be congenital in nature, or may be acquired in adulthood due to posterior tibial tendon dysfunction, which in turn may be caused by trauma, overuse, and inflammatory disorders, among others. Symptoms include dull aching throbbing cramping pain, which in children may be described as growing pains. Conservative treatments may include orthotics or shoe modifications. Additional symptoms include refusal to participate in athletics or walking long distances. Arthroereisis (also referred to as arthroisis) is the limitation of excessive movement across a joint. Subtalar arthroereisis is designed to correct the excessive talar displacement and calcaneal eversion by placing an implant in the sinus tarsi, a canal located between the talus and the calcaneous.
Subtalar arthroereisis has been performed for some 40 years, with a variety of implants designs and compositions. The Maxwell-Brancheau Arthroereisis (MBA) implant is currently favored due to the simple and reversible implantation procedure, although other devices reported in the medical literature include the STA peg and a Kalix device. The MBA implant is described as a reversible and easy to insert device with the additional advantage that it does not require bone cement. In children, insertion of the MBA implant is frequently offered as a stand alone procedure, while adults often require adjunctive surgical procedures on bone and soft tissue to correct additional deformities.
The MBA implant received U.S. Food and Drug Administration (FDA) 510 (k) marketing clearance in 1996 because it was substantially equivalent to products on the market prior to device regulation. According to the FDA summary, the primary indication for the Subtalar MBA device is "as a spacer for stabilization of the subtalar joint. It is designed to block the anterior and inferior displacement of the talus, thus allowing normal subtalar joint motion but blocking excessive pronation and the resulting sequela." The MBAResorb Implant received 510(k) marketing clearance in 2005 (K051611). This implant employs the same basic mechanical features as the predicate MBA implant, but is composed of a material (poly l-lactic acid) that is resorbed by the body.
POLICYSubtalar arthroereisis is considered investigational.
POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
There is no specific CPT code for this procedure.
POLICY HISTORY05/18/2006: Approved by Medical Policy Advisory Committee (MPAC)
5/16/2007: Policy reviewed, MBAResorb Implant added to description
5/21/08: Policy reviewed, no changes
04/09/2010: Policy statement unchanged. FEP verbiage added to the Policy Exceptions section. Added the flat foot ICD-9 codes, 734 and 754.61.
10/21/2010: Policy reviewed; no changes.
10/05/2011: Policy reviewed; no changes.
11/30/2012: Policy reviewed; no changes.
11/15/2013: Policy reviewed; no changes.
SOURCE(S)Blue Cross Blue Shield Association Policy # 7.01.104
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.