CPT 58120, in plain terms, covers Physician dilates the cervix and scrapes the uterine lining to diagnose or treat a nonobstetric condition such as abnormal bleeding. CPT 58120 is referenced in 6 tracked payer policy changes from UnitedHealthcare, Colorado Medicaid, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 58120 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 58120 on AAPC
UnitedHealthcare is removing a long list of CPT codes from the applicable-code list of its Outpatient Surgical Procedures site-of-service policy for Exchange plans, and it is also removing the link to the Manipulation Under Anesthesia policy. The change takes effect December 1, 2026. The source does not state a new billing requirement for the removed codes.
Effective December 1, 2026, UMR removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, UMR's site-of-service policy no longer applies, so the practice should update its internal UMR site-of-service and prior authorization lists before that date.
Effective December 1, 2026, UnitedHealthcare removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, the site-of-service policy no longer applies under this UnitedHealthcare commercial policy, so the practice should update its internal site-of-service and prior authorization lists before that date.
Effective January 1, 2026, the HCPCS codes J1442, Q5125, J2506, Q5111, Q5127, J9312, Q5101, Q5108, Q5122 and Q5130 are added to the physician-administered drug (PAD) list that requires prior authorization (PA). Effective January 1, 2026, outpatient providers can bill transitions of care codes 99495 and 99496 in place of E/M codes 99214 and 99215 for follow-up visits within 14 days of discharge from inpatient or observation-level care. Claims billed with 2026 HCPCS procedure codes may suspend for EOB 0000 beginning January 1, 2026, and all codes must be reviewed for medical necessity, prior authorization coverage standards and rates before they are reimbursable.
Effective November 1, 2026, site of care medical necessity reviews apply to the listed surgical procedures only when they are performed in an outpatient hospital setting. Use of a hospital outpatient department instead of an ambulatory surgery center or physician office may be considered medically necessary when one or more listed criteria are met, such as no geographically accessible in-network ASC that has the necessary equipment, a procedure that requires discontinuing medications that necessitate inpatient monitoring or treatment, ASA Physical Status III or higher, or a BMI over 40. Hospital outpatient use is considered not medically necessary when the criteria are not met.
This surgical site of care policy sets criteria for when a hospital outpatient department may be considered medically necessary instead of an ambulatory surgery center or physician office for listed surgical procedures. Hospital outpatient use may be considered medically necessary when one or more criteria are met, such as no qualifying in-network ASC within 25 miles that can provide the necessary care, an ASA Physical Status Classification of III or higher, a body mass index over 40, or a surgery expected to last longer than 3 hours. Use of a hospital outpatient department instead of an ASC or physician office is considered not medically necessary when the criteria are not met. The procedure may require prior authorization separately under its own medical policy.
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