Hallux Valgus (Bunion)

Utilization Review Checklist

Derived from the ACOEM Ankle and Foot Disorders Guideline, edition 29 January 2026, as adopted into the California MTUS 1 August 2026. CPT 28296, 28292, 28297, 28298, 28299. ICD-10 M20.1.

Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.

Patient name: Claim #:

CriteriaCheck if documented

Confirmatory Diagnosis

Required

X-rays obtained for measuring angles and surgical planning
“X-rays are useful for measuring angles and surgical planning and are recommended.” — p. 202

Surgical Considerations (bunion surgery)

All of the following

Select cases of mostly moderate or severe hallux valgus
“Select cases of mostly moderate or severe hallux valgus” — p. 203
AND
Failure of at least 3 months of nonoperative care and/or valgus angle progression
“where there is failure of at least 3 months of nonoperative care (i.e., orthotics and changing shoe wear) and/or there is valgus angle progression leading to hammer toe, stiffness, and/or overlapping toes.” — p. 203
Any one of the following:
- Failure of at least 3 months of nonoperative care (orthotics and changing shoe wear) — at least 3 months
  “failure of at least 3 months of nonoperative care (i.e., orthotics and changing shoe wear)” — p. 203
- OR
  Valgus angle progression leading to hammer toe, stiffness, and/or overlapping toes
  “there is valgus angle progression leading to hammer toe, stiffness, and/or overlapping toes” — p. 203

Procedures — the guideline treats each separately

Surgery for bunions (hallux valgus)

Recommended.

Strength of Evidence — Recommended, Evidence (C) · confidence low

The guideline offers two alternative routes, not two requirements: either three months of failed nonoperative care, OR valgus angle progression leading to hammer toe, stiffness or overlapping toes. Documenting one of the two is enough. Confidence in this recommendation is Low, so state which route applies rather than leaving the reviewer to work it out.