CommercialCoverageMedium impact
Endometrial Ablation 4.01.01
Excellus BlueCross BlueShield·OB-GYN·Women's Health (Obstetrics & Gynecology)
Effective date
Feb 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their endometrial ablation policy (4.01.01) effective February 19, 2026, establishing comprehensive medical necessity criteria including requirements for failed hormone therapy, normal endometrium documentation, and specific contraindications. The policy clarifies that other ablation methods like chemoablation are considered investigational.
Action Required
Before February 19, 2026: OB-GYN billing team must update prior authorization requirements for endometrial ablation procedures to include all eight criteria: 3+ months of menorrhagia, failed hormone therapy for 3 cycles, severity warranting surgery, ADL interference/anemia, normal Pap within 12 months, normal endometrium documentation within 6-12 months, no pregnancy/future pregnancy desire, and FDA-approved device. Update encounter forms to prompt providers for required documentation. Ensure contraindications screening is documented to avoid claim denials.