Ankle replacement surgery

These services may or may not be covered by all CoOportunity Health plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative process

Prior authorization is required for total ankle replacement (TAR).

Total ankle replacement (TAR) is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

TAR is covered when ALL of the following criteria are met:

1. Skeletally mature person; and
2. Moderate or severe chronic pain with loss of ankle mobility and function that limits activities of daily living; and
3. The condition is due to:
   1. osteoarthritis, or
   2. post-traumatic arthritis, or
   3. severe inflammatory arthritis / rheumatoid arthritis, and
4. Failed at least 6 months of conservative management (including formal physical therapy, medications (analgesic and/or anti-inflammatory), AND orthoses as indicated): and
5. No medical contraindications exist, including, but not limited to:
   
   1. prior infection to the affected joint
   2. severe extremity neuropathy
   3. severe vasculopathy
   4. severely compromised soft tissue envelope

Indications that are not covered

TAR is not covered for any additional indication.

Total ankle replacement involves the surgical removal of a dysfunctional painful ankle joint and its replacement with prosthetic parts. The purpose of total ankle replacement is to relieve pain and restore joint function in patients with medically refractory, end-stage degenerative joint disease resulting from conditions such as osteoarthritis, post-traumatic osteoarthritis, or rheumatoid arthritis.

Arthrodesis is the fusion of a joint. This is an alternative procedure to the total ankle replacement. It does not require prior authorization.

Arthroplasty is surgery to relieve pain and restore range of motion by realigning or reconstructing a joint.

Orthosis (plural orthoses) / orthotic – an orthopedic appliance or apparatus used to support, align, prevent, or correct deformities or to improve function of movable parts of the body. Some people with ankle conditions will use orthosis before moving to a surgical alternative.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

27702 - Arthroplasty, ankle; with implant (total ankle)

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

This information is for most, but not all, CoOportunity Health plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.