All PlansPrior AuthHigh impact
Hysterectomy
Regence BlueShield·OB-GYN·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
New prior authorization policy for hysterectomy procedures effective July 1, 2026. The policy establishes specific medical necessity criteria for 9 conditions including abnormal uterine bleeding, fibroids, endometriosis, and pelvic pain, requiring documentation that conservative treatments were tried or contraindicated before hysterectomy approval.
Action Required
Before July 1, 2026: Billing team must update prior authorization workflow for all hysterectomy procedures. Create documentation checklists for the 9 covered conditions (abnormal bleeding, adenomyosis, CIN, chronic PID, endometriosis, fibroids, pelvic pain, adhesive disease, venous congestion). Ensure providers document required imaging studies, failed conservative treatments, and contraindications. Update EMR templates to capture required clinical documentation including history/physical, conservative treatments tried, and condition-specific criteria. Claims will be denied without proper prior authorization and supporting documentation.