Bunionectomy

Covered when strict criteria are met: simple (soft‑tissue) bunionectomy is covered for skeletally mature patients with persistent symptoms after ≥6 months of conservative care and weight‑bearing radiographs showing HVA ≥15° with no 1st MTP degenerative change (and for diabetics with an ulcer/infection caused solely by the bunion); bony corrective bunionectomy is covered for skeletally mature patients after ≥6 months conservative care with weight‑bearing HVA ≥30° and IMA ≥12° plus at least one complicating finding (e.g., neuroma, crossover toe, limited/painful 1st MTP ROM, ulceration, recurrent bursitis, radiographic osteoarthritis, or predisposing factor like Achilles contracture); first MTP joint procedures are covered for radiographic osteoarthritis after ≥6 months conservative care; and bunionette correction is covered for IMA ≥10° and MTP angle ≥16° after ≥6 months conservative care. Any simple or bony bunionectomy, bunionette correction, cheilectomy, or foot arthrodesis performed for indications not explicitly listed is considered experimental/investigational (not covered).