Utilization Review Checklist
Morton's Neuroma
Derived from the ACOEM Ankle and Foot Disorders Guideline, edition 29 January 2026, as adopted into the California MTUS 1 August 2026. CPT 28080, 64455, 64632. ICD-10 G57.6.
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.
CriteriaCheck if documented
Presumptive Diagnosis
All of the following
Pain, sometimes radiating, between two rays of the forefoot
“A history consistent with Morton’s neuroma is that of pain, sometimes radiating, between two rays of the forefoot.” — p. 208
AND
Discomfort provoked or worsened with compression and weight-bearing activity
“The discomfort is often provoked or worsened with compression and weight-bearing activity.” — p. 208
Confirmatory Diagnosis
Required
Careful history and physical examination, with x-rays to evaluate alternate conditions and for surgical planning
“However, x-rays are commonly needed to evaluate alternate conditions such as osteoarthrosis, gout and degenerative joint disease. Also, x-rays are useful for measuring angles and surgical planning and are recommended.” — p. 209
Conservative Care
Required
Failure of at least 3 months of nonoperative care — at least 3 months
“Select cases where there is failure of at least 3 months of nonoperative care (e.g., oral nonopioid analgesics, orthotics, wide toe-box shoes, metatarsal pads, glucocorticoid injections).” — p. 212
Procedures — the guideline treats each separately
Surgical excision and/or decompression for Morton's neuroma
Recommended. Surgical excision and/or decompression is recommended for Morton’s Neuroma.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence moderate · p. 212
Indications — required:
Surgical excision and/or decompression requested for a select case
“Surgical excision and/or decompression is recommended for Morton’s Neuroma.” — p. 212
Excision carries the higher level of confidence of the two surgical options in this section — Moderate, against Low for nerve ablation — on the same evidence grade. Its stated indication is the three-month failed nonoperative course, nothing more.
Nerve ablation for Morton's neuroma
Recommended. Nerve ablation is recommended for Morton’s Neuroma.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence low · p. 212
Indications — all of the following:
Pain and/or debility are significant
“Select cases where pain and/or debility are significant and changing shoe wear, orthotics and glucocorticoid injection(s) fail to sufficiently control symptoms.” — p. 212
AND
Changing shoe wear, orthotics and glucocorticoid injection(s) failed to sufficiently control symptoms
“changing shoe wear, orthotics and glucocorticoid injection(s) fail to sufficiently control symptoms” — p. 212
Ablation is recommended but at Low confidence. Its indication adds a requirement excision's does not: that pain and/or debility be significant AND that changing shoe wear, orthotics and glucocorticoid injections have each failed. Document all three of those treatments by name.