28060
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
5.27
Facility
$343.70
Non-Facility
$525.06
Documentation Required
- Documentation to support the covered ICD-10 diagnosis (examples listed in policy: M72.2; M77.30 - M77.32).
- For combined steroid/anesthetic injection: documentation that conservative treatments have failed — e.g., attempted stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs (per the policy text: "when conservative treatments (e.g., stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs) have failed").
- For endoscopic plantar fasciotomy: documentation of intractable plantar fasciitis or heel spur syndrome and failure of a 6-month trial of conservative therapy (per the policy text: "who have failed a 6-month trial of conservative therapy").
Key Coverage Criteria
- Plantar fasciitis (including chronic/recalcitrant plantar fasciitis)
- Painful calcaneal spur and plantar heel pain (conditions being evaluated for the listed treatments)
- Combined steroid/anesthetic injection medically necessary for the treatment of plantar fascia when conservative treatments (e.g., stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs) have failed.
- Endoscopic plantar fasciotomy medically necessary as an alternative to conventional open plantar fasciotomy for members with intractable plantar fasciitis or heel spur syndrome who have failed a 6-month trial of conservative therapy.
- CPT codes covered if selection criteria are met: 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")) and 29893 (Endoscopic plantar fasciotomy).
- ICD-10 codes covered if selection criteria are met: M72.2 (Plantar fascial fibromatosis) and M77.30 - M77.32 (Calcaneal spur).
1 Active Policy
AETNA-CPB-0235 — Plantar Fasciitis Treatments
Related Codes
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