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11.06.04k, Uterine Artery Embolization
Independence Blue Cross·PA · OB-GYN, Radiology, Vascular Surgery·Medical Policy
We identified it
Jun 25, 2026
Summary
Independence Blue Cross has reissued Policy 11.06.04k with no substantive changes to coverage criteria for uterine artery embolization (UAE). The policy maintains its existing position: UAE is covered for symptomatic uterine fibroids and postpartum hemorrhage, with specific medical necessity criteria. No workflow changes are required for billing operations.
Action Required
No immediate action required. This is a reissue with no changes to coverage criteria or billing requirements. Billing team should note that Policy 11.06.04k remains in effect with the same medical necessity criteria: UAE coverage for symptomatic uterine fibroids requires documented symptoms (menorrhagia, pelvic pain, back pain, urinary/GI symptoms, or dyspareunia) OR presence of abdominally palpable/significantly enlarged fibroid, plus documentation confirming no absolute contraindications (endometrial/cervical/ovarian cancer, pregnancy, active infection). Continue requiring prior authorization documentation per existing practice. No changes to coding, documentation requirements, or claim submission processes.