Table 3.
Inclusion of Common Coverage Criteria by Commercial Payer.
| Criteria | FDA-Approved Implant | Skeletal Maturity | Failure of Conservative Management | Severe Pain | Loss of Function or Mobility | Advanced Ankle Arthritis | Arthritis of Adjacent Joints | Severe Arthritis of Contralateral Ankle | Arthrodesis (Fusion) of Contralateral Ankle | Presence of Inflammatory Arthritis |
|---|---|---|---|---|---|---|---|---|---|---|
| Aetna | ✓ | ✓ | 6 mo | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Anthem | ✓ | ✓ | 3 mo | ✓ | ✓ | ✓ | ||||
| Cigna | ✓ | ✓ | 6 mo | ✓ | ✓ | ✓ | ✓ | ✓ | ||
| HCSC | ✓ | ✓ | 6 mo | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
| Highmark | ✓ | ✓ | 6 mo | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
Abbreviations: FDA, US Food and Drug Administration; HCSC, Health Care Services Corporation.