CommercialCoverageMedium impact
Transcervical Balloon Tuboplasty (CPB 0347, reviewed 2026-05-21)
Aetna·OB-GYN·Medical Policy
Effective date
Aug 27, 1999
We identified it
Aug 18, 2026
Summary
Aetna's Transcervical Balloon Tuboplasty (TBT) policy (CPB 0347) establishes coverage criteria for this infertility procedure. TBT is medically necessary ONLY for members with infertility due to proximal tubal occlusion demonstrated on hysterosalpingogram; all other indications are considered experimental/investigational and not covered. Billing teams must ensure claims include proper diagnosis coding (N97.1) and use CPT 58345 only when medical necessity criteria are met.
Action Required
Before submitting claims for CPT 58345 (Transcervical introduction of fallopian tube catheter): (1) Billing team must verify that ICD-10 diagnosis code N97.1 (Female infertility of tubal origin) is present on claim; (2) Ensure clinical documentation in patient record confirms proximal tubal occlusion was demonstrated on hysterosalpingogram (HSG); (3) Do NOT bill CPT 58345 for any other indication—all non-proximal occlusion cases will be denied as experimental/investigational; (4) Update billing software to flag claims for manual review if CPT 58345 is billed without N97.1 diagnosis; (5) Provide providers with prior authorization checklist requiring HSG evidence before procedure approval. Claims submitted without proximal tubal occlusion diagnosis will be denied.