High impact
Endometrial Ablation (CPB 0091, reviewed 2026-03-25)
Aetna·Effective Mar 25, 2026
Aetna's Endometrial Ablation policy (CPB 0091, effective 2026-03-25) establishes coverage criteria requiring documented failure of D&C or hormonal therapy, prior endometrial sampling within one year, exclusion of structural abnormalities, and current Pap smear. The policy also specifies approved ablation techniques, excludes certain procedures as experimental (3D ultrasound, combined ablation with IUD, ablation for sterilization), and explicitly covers three CPT codes while denying coverage for specific HCPCS codes (levonorgestrel IUDs) when used with ablation.