Summary
Endometrial ablation, with or without hysteroscopic guidance, using an FDA-approved device is medically necessary for women with abnormal uterine bleeding who are not candidates for, or are unresponsive to, hormone therapy and would otherwise be candidates for hysterectomy. Endometrial ablation is considered investigational for all other indications. The most recent policy review, dated 03/28/2025, reported no changes.
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What to do
Action · 5 steps
01Billing team: Confirm that each endometrial ablation claim meets the policy criteria.
02The patient must have abnormal uterine bleeding, must not be a candidate for or must be unresponsive to hormone therapy, and must otherwise be a candidate for hysterectomy, and the device must be FDA-approved.
03Confirm the patient is not pregnant or does not desire pregnancy, has no history of endometrial cancer or pre-cancerous histology, has no active genital or urinary tract infection or active pelvic inflammatory disease, and has no IUD or Essure device in place.
04The listed codes are only medically necessary if the procedure is performed according to the policy section.
05Endometrial ablation for all other indications is considered investigational.
Codes mentioned
583535835658563N92.0N92.4N95.0
Original notice
Endometrial Ablation
bcbsms.com · Always check the source before changing claims.