CommercialAdministrativeLow impact
11.06.05f, Endometrial Ablation
Independence Blue Cross·PA · OB-GYN, General Surgery·Medical Policy
We identified it
Jun 25, 2026
Summary
Independence Blue Cross has reissued Medical Policy 11.06.05f on endometrial ablation to communicate its continuing position. No substantive changes to coverage criteria, contraindications, or billing codes were made in this reissue—the policy maintains existing coverage for endometrial ablation in premenopausal individuals with abnormal uterine bleeding unresponsive to hormone therapy, with the same contraindications and documentation requirements as previously established.
Action Required
No immediate action required. This is a policy reissue communicating the Company's continuing position with no substantive changes. Billing team should verify that current claim submission practices already comply with existing coverage criteria (medical necessity documentation, absolute contraindication screening, FDA-approved device verification). If not previously implemented, ensure documentation templates include: (1) confirmation of abnormal uterine bleeding diagnosis, (2) documentation that patient is unresponsive to or has contraindication to hormone therapy, (3) confirmation of benign endometrium, (4) screening for all listed absolute contraindications, and (5) verification that procedure uses FDA-approved device. Maintain current billing code usage for CPT 58353, 58356, 58563 and applicable ICD-10 codes (N92.0, N92.1, N92.4, N93.8, N93.9).