28307
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
6.34
Facility
$497.34
Non-Facility
$844.71
Documentation Required
- No documentation requirements are specified in the supplied excerpt.
- Full policy text is required to extract required medical records, test results, and specific documentation language.
- No specific documentation requirements are listed in this document.
- Users are instructed to refer to the CMS Medicare Coverage Database and Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §290 - Foot Care for applicable documentation and coverage details.
Key Coverage Criteria
- Ulceration caused by the deformity
- HCPCS L8658 | Interphalangeal joint spacer, silicone or equal, each
- Osteotomy (cutting portions of bone on each side of the toe joint followed by realignment)
- No explicit covered indications are provided in the supplied excerpt.
- Inferred: Coverage of foot surgical procedures for Medicare Advantage members when medically necessary to treat foot conditions (inferred from the title 'Foot Surgical Procedures' and the document being a 'Medicare Advantage Medical Coverage Policy').
- None explicitly stated in this document. The document directs readers to CMS resources (CMS Medicare Coverage Database and Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §290 - Foot Care) for covered indications.
3 Active Policies
CARELON-level-of-care-for-surgical-procedures-2025-11-15 — Level of Care for Surgical Procedures
CARELON-small-joint-surgery-2025-11-15 — General Requirements and Documentation
HUMANA-FOOT-SURGICAL-PROCEDURES-MA — Foot Surgical Procedures - Medicare Advantage
Related Codes
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