Does L8642 require prior authorization?

Yes, L8642 requires prior authorization (high confidence). Code explicitly requires prior authorization.

`L8642`, Hallux implant

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

- Appropriate ICD-10 diagnosis code: M20.20 - M20.22 (when claiming covered procedures)
- Operative plan indicating intended procedure (hemiarthroplasty or total prosthetic replacement with silastic implant such as In2Bones RTS) and implant identification (manufacturer/model) when applicable
- Pre-operative imaging (radiographs and any other relevant imaging) documenting joint degeneration consistent with hallux rigidus
- Evidence of prior conservative treatment attempts (conservative therapies are emphasized in the background: exercise, physiotherapy, orthoses, NSAIDs, steroid injections) — policy references conservative treatment but does not state an explicit prior-therapy requirement

Arthrodesis (first MPJ arthrodesis): 'remains the gold standard for arthritis and salvage of the painful first MPJ' and 'support the use of arthrodesis for the treatment of stage III hallux rigidus.'
Interpositional (soft-tissue/biologic spacer) arthroplasty: as a motion-sparing/salvage procedure for severe hallux rigidus to relieve pain while preserving motion (reported in case series and retrospective studies).
Silicone (silastic) double-stem flexible implants (with titanium grommets) and metallic hemi-arthroplasty: used for replacement arthroplasty of the first MPJ in patients with painful/destroyed joints (historical and investigational use described).
Disabling arthritis of the first metatarsal phalangeal joint (hallux rigidus)
Hemiarthroplasty for persons with disabling arthritis of the first metatarsal phalangeal joint (hallux rigidus)
CPT codes covered if selection criteria are met: 28291 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant)

CIGNA-0446, Metatarsophalangeal Joint Replacement

AETNA-CPB-0708, Metatarsal Phalangeal Joint Replacement

EVICORE-HPLAN-CIGNA-1815296EE67F, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-FE6FBAF45728, Cigna Commercial Joint Surgery Code List - Effective 03/07/2026

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