Cigna modified MM 0486 for subtalar arthroereisis, effective October 16, 2025. Every indication under this policy — CPT 0335T, 0511T, 28899, and HCPCS S2117 — is classified as Experimental/Investigational/Unproven. Here's what billing teams need to do.
Cigna Healthcare's coverage policy MM 0486 in the Cigna payer system covers subtalar joint implantation, also called subtalar arthroereisis or extraosseous subtalar joint implantation. This procedure involves inserting an implant into the sinus tarsi to treat conditions like pes planus, posterior tibial tendon dysfunction, and talotarsal joint dislocation. The October 16, 2025 modification keeps all four codes — including the insertion code 0335T and the removal/reinsertion code 0511T — firmly in the non-covered column. If your practice performs this procedure or bills for it on Cigna patients, you need to act before claims start hitting a wall.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy Title | Subtalar Joint Implantation (Subtalar Arthroereisis) |
| Policy Code | MM 0486 |
| Change Type | Modified |
| Effective Date | October 16, 2025 |
| Impact Level | High |
| Specialties Affected | Podiatry, Orthopedic Surgery, Pediatric Orthopedics |
| Key Action | Flag CPT 0335T, 0511T, 28899, and HCPCS S2117 as non-covered in your charge capture before October 16, 2025 |
Cigna Subtalar Arthroereisis Coverage Criteria and Medical Necessity Requirements 2025
The short answer: Cigna does not cover subtalar arthroereisis for any indication. The Cigna subtalar arthroereisis coverage policy under MM 0486 classifies this procedure as Experimental/Investigational/Unproven across the board. That designation applies regardless of the patient's diagnosis — whether it's pes planus, posterior tibial tendon dysfunction, or talotarsal joint dislocation.
Medical necessity does not apply here the way it does with other surgical procedures. Under most Cigna policies, a patient can meet medical necessity criteria and get reimbursement. Under MM 0486, there's no path to coverage. The payer's position is that the clinical evidence doesn't support this procedure's routine use, so no documentation of conservative treatment failure, severity of deformity, or functional limitation will change the outcome.
This is not a prior authorization situation where the right paperwork unlocks payment. Prior authorization for a procedure Cigna considers experimental won't result in approval. If a provider asks your billing team about getting prior auth on one of these codes, stop the conversation there — prior auth isn't the mechanism that will make this payable under Cigna.
The real risk here is providers who perform subtalar arthroereisis believing their documentation is strong enough to overcome Cigna's position. It isn't. The E/I/U designation in this coverage policy is a blanket exclusion, not a threshold to clear.
Cigna Subtalar Arthroereisis Exclusions and Non-Covered Indications
Every indication the procedure has been proposed for falls into non-covered status under MM 0486. This includes:
Pes planus (flatfoot deformity): Inserting a sinus tarsi implant to correct flexible flatfoot — whether in pediatric or adult patients — is not covered.
Posterior tibial tendon dysfunction: Using subtalar arthroereisis as part of treatment for PTTD is not covered, regardless of staging or severity.
Talotarsal joint dislocation: Extraosseous subtalar joint implantation for talotarsal instability or dislocation is not covered.
The policy makes no distinction based on patient age, severity, prior conservative treatment, or implant type. Cigna treats the procedure itself as unproven. That's a meaningful distinction from policies where coverage turns on clinical criteria — here, the procedure category is the exclusion.
The unlisted procedure code 28899 is also caught in this designation. Some billing teams use 28899 as a catch-all when a more specific code doesn't exist or when a payer hasn't loaded a Category III code properly. Under MM 0486, Cigna has explicitly grouped 28899 with the procedure-specific codes 0335T and 0511T, and with HCPCS S2117. Don't assume 28899 will behave differently on a claim — it won't.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Pes planus (flatfoot) | Experimental/Investigational/Unproven | 0335T, 0511T, 28899, S2117 | No coverage path under MM 0486 |
| Posterior tibial tendon dysfunction | Experimental/Investigational/Unproven | 0335T, 0511T, 28899, S2117 | No documentation overrides this designation |
| Talotarsal joint dislocation | Experimental/Investigational/Unproven | 0335T, 0511T, 28899, S2117 | Applies to extraosseous sinus tarsi implantation specifically |
| Removal and reinsertion of sinus tarsi implant | Experimental/Investigational/Unproven | 0511T | Even revision procedures are non-covered |
Cigna Subtalar Arthroereisis Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Update your charge capture before October 16, 2025. Flag CPT 0335T, 0511T, 28899, and HCPCS S2117 as non-covered for Cigna patients. Every claim that goes out after the effective date without this flag is a denial waiting to happen. |
| 2 | Build a hard stop into your scheduling workflow for Cigna patients. If a provider schedules a subtalar arthroereisis procedure on a Cigna-insured patient, your front-end team needs to know this is non-covered before the patient hits the OR. Financial counseling before the procedure date — not after — is the only way to avoid patient complaints and collection problems post-service. |
| 3 | Do not pursue prior authorization as a workaround. Subtalar arthroereisis billing on Cigna won't succeed through the prior auth channel. Experimental/Investigational/Unproven procedures are excluded from coverage at the plan level. A prior auth request for 0335T or S2117 will be denied on coverage grounds, not medical necessity grounds, and that distinction matters for your appeals strategy. |
| 4 | Prepare an Advance Beneficiary Notice equivalent for commercial patients. Cigna isn't Medicare, so it's not a formal ABN — but your practice should have a financial responsibility agreement that documents the patient understood this procedure isn't covered before consenting to it. This protects you from claim denial disputes that become patient balance disputes. |
| 5 | Audit any open claims or pre-authorizations that include 0335T, 0511T, 28899, or S2117 for Cigna patients. If you have claims in the pipeline from before October 16, 2025, review them now. The modification may affect how Cigna processes claims that were already submitted but not yet adjudicated. |
| 6 | Talk to your compliance officer if you have a high volume of this procedure in your practice. The E/I/U designation creates downstream risk beyond just claim denials — it can trigger audit scrutiny if billing patterns show repeated submissions of a non-covered procedure. If your podiatry or orthopedic group does this procedure regularly, loop in your compliance officer before the effective date to assess exposure. |
| 7 | Review your contract terms with Cigna. Some plans have carve-outs or rider language that modifies what's covered under a specific policy. Don't assume MM 0486 applies identically to every Cigna product your practice is contracted under. Check for plan-specific exceptions, especially for self-funded employer plans where the employer — not Cigna — sets the coverage terms. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Subtalar Arthroereisis Under MM 0486
Not Covered / Experimental Codes
All codes under MM 0486 carry the Experimental/Investigational/Unproven designation. There are no covered codes under this policy.
| Code | Type | Description | Status |
|---|---|---|---|
| 0335T | CPT | Insertion of sinus tarsi implant | Experimental/Investigational/Unproven |
| 0511T | CPT | Removal and reinsertion of sinus tarsi implant | Experimental/Investigational/Unproven |
| 28899 | CPT | Unlisted procedure, foot or toes | Experimental/Investigational/Unproven |
| S2117 | HCPCS | Arthroereisis, subtalar | Experimental/Investigational/Unproven |
A note on CPT 0335T and 0511T: These are Category III codes — temporary tracking codes for emerging technologies. Cigna's inclusion of both the insertion code (0335T) and the removal/reinsertion code (0511T) tells you they're covering the full procedure lifecycle in the exclusion. Even if a patient had a sinus tarsi implant placed before October 16, 2025 and now needs a revision, the 0511T claim hits the same wall.
A note on 28899: This unlisted code gets used in different contexts across foot and ankle billing. Its inclusion here is specific to subtalar arthroereisis. If you use 28899 for other foot procedures, don't let this policy create confusion — the E/I/U designation in MM 0486 applies to 28899 when used for sinus tarsi implantation, not categorically.
A note on HCPCS S2117: S2117 is a non-Medicare code — it appears in commercial payer fee schedules. Some Cigna plans may process this code while others don't recognize it at all. Either way, under MM 0486, it's non-covered. Don't bill S2117 expecting different results than 0335T.
No ICD-10-CM codes are listed in MM 0486. The policy applies its exclusion at the procedure level, not the diagnosis level.
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