CMM-407: Arthroscopy Subtalar Joint

Subtalar joint arthroscopy is medically necessary only when all criteria are met — a listed indication (e.g., chronic subtalar pain ≥3 months, loose body, synovitis, or arthritis) plus qualifying subjective and objective findings, inconclusive imaging, and failure of ≥6 weeks of conservative care — and is not covered with contraindications such as active intraarticular/soft‑tissue infection, inability to tolerate surgery/rehab, complete joint‑space loss (except arthrodesis), peripheral vascular disease, inability to comply with weight‑bearing restrictions, or for red‑flag emergencies (septic arthritis, acute dislocation post‑reduction). Required documentation includes plain X‑rays and MRI/CT as indicated, records of symptoms and objective exam findings, documentation that imaging is inconclusive when applicable, proof of ≥6 weeks of conservative treatments (or contraindication), assessment of comorbidities/anesthesia risk, confirmation patient can comply with postoperative rehabilitation/weight‑bearing, and evidence of less than a clinically meaningful response to nonoperative care (<50% improvement).