Summary
Effective July 1, 2026, hysterectomy may be considered medically necessary when the policy criteria are met for abnormal uterine bleeding, pelvic pain, endometriosis, chronic pelvic inflammatory disease, pelvic adhesive disease, pelvic venous congestion, adenomyosis, cervical intraepithelial neoplasia, or leiomyoma. Hysterectomy for these indications is considered not medically necessary when the criteria are not met, and clinical documentation supporting the criteria is required.
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What to do
Action · 6 steps
01Already effective July 1, 2026: Confirm the clinical records document all the criteria listed for the diagnosis before billing hysterectomy for abnormal uterine bleeding, pelvic pain, endometriosis, chronic pelvic inflammatory disease, pelvic adhesive disease, pelvic venous congestion, adenomyosis, cervical intraepithelial neoplasia, or leiomyoma.
02Submit the required documentation for review: history and physical or chart notes, conservative treatment provided, relevant imaging reports (ultrasound, CT, hysteroscopy etc), and lab or pathology reports.
03If any of these items are not submitted, it could impact the review and decision outcome.
04Where conservative management is contraindicated, not tolerated, unsuccessful, or declined by choice, record the specific reasons in the chart notes.
05Hysterectomy performed in a hospital outpatient department instead of an ambulatory surgery center may require review.
06Check current applicability of this version before billing these services.
Codes mentioned
58150581525818058260582625826758270582755828058290582915829258294585415854258543585445855058552585535855458570585715857258573D06.9D25.9G89.29K66.0N70.01N71.9N73.9N80.00N80.03N80.9N87.9N92.0N93.9N94.6N95.0N99.4R10.20
Original notice
Hysterectomy
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Related changes
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Regence BlueShield policiesOB-GYNGeneral SurgeryCode 58150Code 58152Code 58180Code 58260Code 58262Code 58267Code 58270Code 58275Code 58280Code 58290Code 58291Code 58292Code 58294Code 58541Code 58542Code 58543Code 58544Code 58550Code 58552Code 58553Code 58554Code 58570Code 58571Code 58572Code 58573Code D06.9Code D25.9Code G89.29Code K66.0Code N70.01Code N71.9Code N73.9Code N80.00Code N80.03Code N80.9Code N87.9Code N92.0Code N93.9Code N94.6Code N95.0Code N99.4Code R10.20