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AetnaAll Plans · Coverage · Medical Policy · OB-GYN, RadiologyMedium impact

Fibroid Treatment (CPB 0304, reviewed 2026-04-17)

Effective date
Not stated in the notice
Identified
Aug 16, 2026

Summary

Aetna considers radiofrequency ablation or transcatheter uterine artery embolization medically necessary as an alternative to hysterectomy or myomectomy for uterine fibroids when the member has persistent symptoms directly attributed to the fibroids, such as excessive menstrual bleeding, bulk-related pelvic pain, pressure or discomfort, urinary symptoms from compression of the ureter or bladder, or dyspareunia. Aetna considers myomectomy or hysterectomy using power morcellation experimental, investigational, or unproven, except in women without known or strongly suspected uterine cancer who meet the listed exception criteria, such as premenopausal women who wish to maintain fertility and have no risk factors for uterine sarcoma. Aetna also considers cryomyolysis, cryotherapy, electrical ablation, interstitial thermotherapy, laparoscopic uterine artery occlusion, lasers, focused ultrasound ablation, acupuncture, and other uses of transcatheter uterine artery embolization experimental, investigational, or unproven.

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What to do

Action · 6 steps
01Billing team: For radiofrequency ablation (CPT 58580 or 58674) or uterine artery embolization (CPT 37243), confirm the record shows persistent symptoms directly attributed to the fibroids.
02The covered diagnosis codes are D25.0 through D25.9 (uterine leiomyoma) when selection criteria are met.
03For myomectomy or hysterectomy with power morcellation, the policy covers those procedures only in the listed exception cases, and the member must be informed of alternative procedures for fibroids and of the risks of power morcellation in spreading unsuspected cancerous tissue beyond the uterus.
04The policy lists CPT 58140 through 58146, 58150 through 58294, 58541 through 58544, 58545 through 58546, 58548, 58550 through 58554, 58570 through 58573, 58953 through 58954, and 58956 as not covered when performed using power morcellation, with HCPCS C1782 (morcellator) and ICD-10 E66.01 (morbid obesity) covered when selection criteria are met.
05Check diagnosis codes against the policy's contraindicated ICD-10 list before billing, which includes malignant neoplasms of the genitourinary organs (C51.0 through C68.9), urinary tract infection (N39.0), cystitis (N30.00 through N30.91), inflammatory disease of female pelvic organs (N70.01 through N73.9), and personal history of irradiation (Z92.3).
06CPT 0071T and 0072T (focused ultrasound ablation), 37617, 58353, 58356, and 97810 through 97814 (acupuncture) are listed as not covered for the indications in this policy.

Codes mentioned

3724358580586743761758353583569781097814C1782D25.0D25.958140581465815058294585415854458545585465854858550585545857058573589535895458956E66.01C41.4C51.0C68.9C76.3N30.00N30.91N39.0N70.01N73.9N95.0N95.9N97.0N97.9Z78.0Z79.890Z85.40Z85.44Z92.3C18.3C20C54.0C54.9C64.1C64.9C69.20C69.22D48.110D48.19Z84.81Z85.3

Original notice

Fibroid Treatment (CPB 0304, reviewed 2026-04-17)
aetna.com · Always check the source before changing claims.
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