CPT 58661, in plain terms, covers A minimally invasive procedure where a surgeon removes the ovaries and fallopian tubes through small abdominal incisions using a camera. CPT 58661 is referenced in 10 tracked payer policy changes from Sentara Health Plans, Blue Cross Blue Shield of Rhode Island, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 58661 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 58661 on AAPC
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
BCBSRI has implemented multiple policy changes affecting preventive services, coding, and reimbursement across various specialties. Key changes include new breast cancer screening coverage requirements, updated STI testing billing procedures, hearing aid coverage increases, and several new CPT/HCPCS codes for various services.
Premera's December 2024 medical policy and coding update adds medical necessity criteria for lymphedema and lipedema surgery, a new shoulder arthroplasty policy, and new or revised criteria for drugs including Ocrevus Zunovo, Dupixent, Ebglyss, Leqselvi and Wegovy. It also lists coding updates that require review for medical necessity and prior authorization, including cervical spine surgery codes 63001, 63015, 63040, 63050, 63051, 63075, 63081 and 63265, and it places infusion drugs such as Tyruko and Alyglo under site-of-service review.
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.
Effective 10/01/2026, the code reference adds ICD-10 diagnosis codes QA1.790 (familial cancer syndrome with pathogenic BRCA1 mutation), QA1.791 (familial cancer syndrome with pathogenic BRCA2 mutation), and QA1.792 (Li Fraumeni syndrome). Prophylactic oophorectomy is considered medically necessary in women with a confirmed BRCA mutation, and in women who are verified members of a site-specific ovarian cancer family, after childbearing has been completed or after age 35, when appropriate genetic counseling and an accurate risk assessment have been performed. It is considered investigational for women in HNPCC families, for women with relatives with breast or ovarian cancer who are not verified site-specific family members or verified BRCA carriers, and for women at average risk.
Aetna considers electrocoagulation, the Falope ring, the Filshie clip, the Hulka-Clemens clip, partial salpingectomy (Pomeroy and Parkland techniques) and total salpingectomy medically necessary for tubal sterilization. Aetna considers hysteroscopic tubal sterilization, including the Essure Micro-Insert, and the FemBloc permanent contraceptive system experimental, investigational, or unproven because their safety and long-term effects have not been established. CPT codes 58340, 58600, 58605, 58611, 58615, 58661, 58670, 58671, 58700 and 74740 are covered when selection criteria are met.
Aetna considers electrocoagulation, the Falope ring, the Filshie clip, the Hulka-Clemens clip, partial salpingectomy (Pomeroy and Parkland techniques) and total salpingectomy medically necessary for tubal sterilization. Hysteroscopic tubal sterilization, such as the Essure Micro-Insert, and the FemBloc permanent contraceptive system are considered experimental, investigational, or unproven for birth control and all other indications because their safety and long-term effects have not been established. The manufacturer (Hologic) has discontinued production of the Adiana Permanent Contraception System.
Aetna considers prophylactic mastectomy medically necessary for reduction of breast cancer risk in listed high-risk women, including women diagnosed with breast cancer at 45 years of age or younger, women with a BRCA1 or BRCA2 mutation confirmed by molecular susceptibility testing, and women who received radiation treatment to the chest between ages 10 and 30. Prophylactic bilateral oophorectomy or salpingo-oophorectomy is medically necessary for selected women with listed risk factors who meet specific family history or germline mutation criteria, and germline multigene panel testing is medically necessary once per lifetime for persons who meet one or more NCCN testing criteria for high-penetrance breast cancer susceptibility genes. Testing for BARD1, MUTYH, NBN, and other genes or indications not listed in the policy is not covered.
Aetna's Clinical Policy Bulletin 0512 considers gynecological consultation, a medical evaluation with complete medical history and physical examination, thyroid function tests, cognitive behavioral therapy and bilateral oophorectomy medically necessary for premenstrual syndrome and premenstrual dysphoric disorder, with oophorectomy reserved for severe symptoms when all medical therapy has failed or produced unacceptable side effects. Psychiatric or psychological consultation and testing are medically necessary when the member exhibits mental or nervous symptoms. The policy lists acupuncture, aromatherapy, light therapy, intravenous magnesium, intravenous vitamin B6 and vitamin E, reflexology, vestibular stimulation, endometrial ablation, and several laboratory and neuroimaging tests as experimental, investigational or unproven.
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