CMM-407: Arthroscopy Subtalar Joint

Subtalar joint arthroscopy is covered as medically necessary for diagnostic or therapeutic management of subtalar pathology (e.g., indeterminate subtalar pain ≥3 months, loose/foreign body, synovitis, arthritis/arthrodesis, instability/impingement) when imaging is inconclusive, and is excluded for active intraarticular or surrounding infection, complete joint space loss (except arthrodesis), peripheral vascular disease, unsafe comorbidities/anesthesia risk, or inability to comply with weight‑bearing/rehabilitation. Coverage requires plain radiographs plus MRI or CT, documented subjective and objective findings, ≥6 weeks of conservative care without a clinically meaningful (≥50%) improvement, documentation of a subtalar corticosteroid injection unless contraindicated, exclusion of infection, and confirmation the patient is medically fit and can comply with postoperative restrictions.

"Subtalar joint pain of indeterminate etiology of at least 3 months"