Pip scaffold brackets8/25/2023 ICD-10 codes not covered for indications listed in the CPB (not all inclusive): Resurfacing Arthroplasty of the proximal interphalangeal (PIP) joint: Osteoarthritis and allied disorders, hand ICD-10 codes covered if selection criteria are met : stainless steel or cobalt chrome), ceramic-like (pyrocarbon) for surgical implantation, any size Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g. Interphalangeal joint spacer, silicone or equal pyrocarbon), for surgical implantation (all sizes, including entire system) stainless steel or cobalt chrome), ceramic-like material (e.g. Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g. HCPCS codes covered if selection criteria are met: Table: CPT Codes / HCPCS Codes / ICD-10 Codes CodeĬPT codes covered if selection criteria are met:Īrthroplasty, metacarpophalangeal joint with prosthetic implantĪrthroplasty, interphalangeal joint with prosthetic implant See also CPB 0708 - Metatarsal Phalangeal Joint Replacement. Silicone-elastomer MCP and PIP total joint implants.Īetna considers MCP and PIP joint implants for all other indications experimental and investigational because their value is unproven for all other indications.Īetna considers distal interphalangeal (DIP) joint implants/splints experimental and investigational for members with symptomatic rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, or post-traumatic arthritis because their value is unproven for these and all other indications.Īetna considers resurfacing arthroplasty of the PIP joint experimental and investigational in the treatment of osteoarthritis and all other indications.Īetna considers carpometacarpal (CMC) joint / trapeziometacarpal (TMC) joint implants experimental and investigational for members with symptomatic rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, or post-traumatic arthritis because their value is unproven for these and all other indications.Īetna considers the CapFlex-PIP implant experimental and investigational for PIP joint arthroplasty because its value is unproven.Īetna considers the ln2Bones Duafit interphalangeal implant experimental and investigational for DIP joint with osteoarthritis because its value is unproven.Īetna considers the X-Fuse implant experimental and investigational for DIP joint arthrodesis because its value is unproven.Avanta MCP and PIP joint implants when soft tissue and bone can provide adequate stabilization and fixation, and the member expects to place his/her hands under high-loading situations after reconstruction or.Ascension PIP joint implants when soft tissue and bone can provide adequate stabilization and fixation, and the member expects to place his/her hands under high-loading situations after reconstruction or.Ascension MCP joint implants / Integra PyroCarbon MCP Total Joint of the index, long, ring, and small finger when soft tissue reconstruction can provide adequate stabilization or.Number: 0798 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background ReferencesĪetna considers the following metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint implants medically necessary for members with symptomatic rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, or post-traumatic arthritis when conservative medical management fails to relieve pain or when digit deformity is interfering with hand function and activities of daily living:
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