Metatarsal Phalangeal Joint Replacement

Aetna covers hemiarthroplasty and total prosthetic replacement arthroplasty with silastic implants (e.g., In2Bones RTS) for disabling first metatarsophalangeal joint (hallux rigidus) arthritis — CPT codes 28291, 26535, and 26536 are covered when the plan’s selection criteria for this indication are met. Aetna deems Accu-Joint Hemi, bioabsorbable RegJoint, ceramic prostheses (e.g., Moje), interpositional biologic spacers (e.g., InterPhlex), and total metallic implants experimental/investigational and not covered due to insufficient evidence of effectiveness/durability.

"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."

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