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Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome 4.01.10
Effective date
Sep 17, 2026
Identified
Jun 20, 2026
Summary
Effective September 17, 2026, endovascular occlusion of the ovarian and/or internal iliac veins is considered investigational for treating pelvic congestion syndrome. The annual review on that date left the policy intent unchanged. No randomized controlled trials have been published comparing endovascular occlusion for pelvic congestion syndrome with a relevant comparator or sham or placebo treatment, and there is insufficient evidence to conclude a cause and effect relationship between venous congestion and chronic pelvic pain.
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What to do
Action · 3 steps
01Already effective September 17, 2026: Claims for endovascular occlusion of the ovarian or internal iliac veins for pelvic congestion syndrome fall under this investigational statement.
02CPT 37241 and 75894 are marked (E/I) for the ICD-10-CM diagnosis codes listed in the policy, which are I86.2, N94.89, and R10.2.
03Services are contract dependent, and if a product does not cover a service, medical policy criteria do not apply.
Codes mentioned
3724175894I86.2N94.89R10.2
Original notice
Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome 4.01.10
excellusbcbs.com · Always check the source before changing claims.
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