ICD-10 N93.9 is officially defined as "Abnormal uterine and vaginal bleeding, unspecified." code N93.9 is referenced in 12 tracked payer policy changes from Health Net, Regence BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code N93.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Health Net updated 22 medical policies in Q4 2019, including new policies for Antithrombin III treatment, implantable hypoglossal nerve stimulation, and video EEG monitoring. Key changes include lowered colorectal cancer screening age to 45, updated bariatric surgery criteria, and multiple billing code additions/removals across various specialties.
Health Net updated 25 medical policies for Q4 2019, affecting prior authorization requirements, billing codes, and coverage criteria across multiple specialties. Key changes include new prior auth requirements for antithrombin III, hypoglossal nerve stimulation, and video EEG, plus updated criteria for bariatric surgery, cardiac risk assessment, and various pain management procedures.
Health Net updated 25+ medical policies in Q4 2019 with significant changes to prior authorization requirements, coverage criteria, and billing codes across multiple specialties. Key changes include updated bariatric surgery criteria, new DNA stool screening age range (45-85), added prior authorization requirements for various procedures, and terminology updates for gender-affirming procedures.
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.
Effective July 1, 2026, hysterectomy may be considered medically necessary when the policy criteria are met for abnormal uterine bleeding, pelvic pain, endometriosis, chronic pelvic inflammatory disease, pelvic adhesive disease, pelvic venous congestion, adenomyosis, cervical intraepithelial neoplasia, or leiomyoma. Hysterectomy for these indications is considered not medically necessary when the criteria are not met, and clinical documentation supporting the criteria is required.
The 02/19/26 annual review of Excellus policy 4.01.01 Endometrial Ablation replaced the policy statement on using endometrial ablation for gender dysphoria with a reference to Corporate Medical Policy 3.01.22 Gender Affirming Behavioral Health and Medical Services. The policy considers endometrial ablation medically appropriate only when all listed criteria are met, including menorrhagia for more than three menstrual cycles, failure of or a contraindication to hormone therapy over three consecutive cycles, symptoms that interfere with activities of daily living or anemia unresponsive to treatment, a normal Pap smear within the past 12 months, a normal endometrium within the last six to 12 months, no pregnancy or desire for future pregnancy, and FDA approval of the device. Listed contraindications include known or suspected endometrial carcinoma, an enlarged uterus greater than 10 cm in length, submucosal myomas, active genital or urinary tract infection, and an intrauterine device in place.
Aetna considers endometrial biopsy medically necessary for the diagnostic evaluation of abnormal uterine bleeding in women suspected of having endometrial hyperplasia or endometrial carcinoma, and for endometrial cancer surveillance in women with Lynch syndrome. The endometrial brush (Tao brush) is an acceptable alternative to a suction curette such as the Pipelle for medically necessary sampling. Sentinel lymph node mapping is medically necessary for pathologic evaluation and surgical staging in persons with endometrial cancer and endometrial intraepithelial neoplasia (EIN), while endometrial biopsy for screening and many biomarker and genetic tests for endometrial cancer are experimental, investigational, or unproven.
Aetna considers medroxyprogesterone acetate injection (Depo-Provera CI or generic 150 mg/mL) medically necessary for pregnancy prevention and for gender dysphoria when the listed criteria are met. It considers the etonogestrel subdermal implant (Nexplanon) medically necessary for pregnancy prevention and for primary or secondary dysmenorrhea associated with endometriosis in adolescents, and it considers progestin-releasing IUDs (Kyleena, Mirena, Skyla and Liletta) medically necessary for contraception or heavy menstrual bleeding. Progesterone intramuscular injection is medically necessary for amenorrhea or abnormal uterine bleeding due to hormonal imbalance without organic pathology, and the policy considers it experimental, investigational, or unproven for other indications, including pregnancy prevention, twin pregnancies, endometrial hyperplasia, premenstrual syndrome and stroke.
Independence Blue Cross reissued MA11.065d on 06/24/2026 to communicate the Company's continuing position on endometrial ablation coverage for Medicare Advantage members. The policy maintains existing medical necessity criteria, absolute contraindications, and FDA-approved device requirements with no substantive changes to coverage or billing guidance.
Independence Blue Cross reissued MA11.065d on 06/24/2026 to communicate the Company's continuing position on endometrial ablation coverage for Medicare Advantage members. The policy maintains existing coverage criteria, absolute contraindications, and medical necessity requirements with no substantive changes to billing, coding, or coverage rules.
Independence Blue Cross has reissued Medical Policy 11.06.05f on endometrial ablation to communicate its continuing position. No substantive changes to coverage criteria, contraindications, or billing codes were made in this reissue—the policy maintains existing coverage for endometrial ablation in premenopausal individuals with abnormal uterine bleeding unresponsive to hormone therapy, with the same contraindications and documentation requirements as previously established.
Independence Blue Cross reissued its Endometrial Ablation policy (11.06.05f) on 06/24/2026 to communicate the company's continuing position. This is a routine reissue with no substantive changes to coverage criteria, contraindications, or billing codes. The policy maintains coverage for endometrial ablation in premenopausal individuals with abnormal uterine bleeding who are unresponsive to hormone therapy, subject to documented medical necessity and absolute contraindications.
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