Metatarsophalangeal Joint Replacement - (0446)

Cigna covers partial or total replacement of the first MTP joint (e.g., CPT 28291; HCPCS L8641/L8642) only as an alternative to arthrodesis for patients with persistent severe disabling hallux valgus or hallux rigidus from degenerative joint disease who have failed conservative management, and expressly excludes/considers experimental replacement using ceramic (Moje), synthetic cartilage (Cartiva), patient‑specific/3D‑printed implants, MTP replacements for lesser toes, other toe joint replacements, and TMT joint replacements. Approval requires documentation of the diagnosis and failed conservative therapy, preoperative imaging, operative/device records, informed consent/alternative discussion, and correct covered coding; claims lacking required documentation or covered codes will be denied.

"Partial or total replacement of the first metatarsophalangeal (MTP) joint is considered medically necessary as an alternative to arthrodesis when BOTH of the following criteria have been met:"