Table 4.
Number and Percentage of References Cited by Each Payer That Mention Their Specific Coverage Criteria.
| FDA Approved Implant, n (%) | Mentions Skeletal Maturity, n (%) | Failure of Conservative Management, n (%) | Severe Pain, n (%) | Loss of Function or Mobility, n (%) | Advanced Ankle Arthritis, n (%) | Arthritis of Adjacent Joints, n (%) | Severe Arthritis of Contralateral Ankle, n (%) | Arthrodesis (Fusion) of Contralateral Ankle, n (%) | Presence of Inflammatory Arthritis (eg, Rheumatoid), n (%) | Adequate Lower-Extremity Vascular Perfusion, n (%) | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Aetna | 61 (53.0) | 10 (8.7) | 2 (1.7) | 44 (38.3) | 35 (30.4) | 104 (90.4) | 10 (8.7) | 16 (13.9) | 11 (9.6) | 81 (70.4) | 35 (30.4) |
| Anthem | 31 (62.0) | 5 (10.0) | 1 (2.0) | 7 (14.0) | 11 (22.0) | 37 (74.0) | 5 (10.0) | 0 (0.0) | 8 (16.0) | 18 (36.0) | 19 (38.0) |
| Cigna | 38 (64.4) | 7 (11.9) | 2 (3.4) | 16 (27.1) | 20 (33.9) | 46 (78.0) | 3 (5.1) | 4 (6.8) | 2 (3.4) | 25 (42.4) | 26 (44.1) |
| HCSC | 23 (69.7) | 0 (0.0) | 2 (6.1) | 13 (39.4) | 10 (30.3) | 25 (75.8) | 3 (9.1) | 3 (9.1) | 5 (15.2) | 26 (78.8) | 12 (36.4) |
| Highmark | 4 (26.7) | 1 (6.7) | 1 (6.7) | 6 (40.0) | 4 (26.7) | 14 (93.3) | 1 (6.7) | 0 (0.0) | 0 (0.0) | 12 (80.0) | 3 (20.0) |
| United | 0 (0.0) | 2 (33.3) | 1 (16.7) | 6 (100.0) | 5 (83.3) | 6 (100.0) | 2 (33.3) | 0 (0.0) | 0 (0.0) | 1 (16.7) | 1 (16.7) |
| Total | 135 (56.7) | 22 (9.2) | 6 (2.5) | 80 (33.6) | 74 (31.1) | 199 (83.6) | 22 (9.2) | 18 (7.6) | 23 (9.7) | 139 (58.4) | 86 (36.1) |
Abbreviations: FDA, US Food and Drug Administration; HCSC, Health Care Services Corporation.