All PlansCoverageLow impact
Tubal Sterilization (CPB 0657, reviewed 2026-10-07)
Aetna·OB-GYN, General Surgery·Medical Policy
We identified it
Oct 13, 2026
Summary
This is a policy review (not a change) of Aetna's tubal sterilization coverage. The policy reaffirms that electrocoagulation, Falope ring, Filshie clip, Hulka-Clemens clip, partial salpingectomy, and total salpingectomy are medically necessary; hysteroscopic tubal sterilization (Essure) and FemBloc remain experimental/investigational. No effective date change is stated—this is a standard policy document reviewed on 2026-10-07.
Action Required
No immediate action required. This policy document is a standard clinical policy bulletin review dated 2026-10-07 with no stated effective date change. Billing teams should verify current applicability of tubal sterilization coverage and code utilization guidelines by confirming this policy remains active with Aetna. Ensure billing software reflects coverage for codes 58340, 58600, 58605, 58611, 58615, 58661, 58670, 58671, 58700, and 74740 as medically necessary when selection criteria are met; deny claims for code 58565 (hysteroscopic bilateral fallopian tube cannulation) and A4264 (Essure microinsert) as experimental/investigational for birth control indications. Apply appropriate contraindication codes (N73.0-N73.9, O00.00-O9A.53, Q50.6, Q51.x, Z34.00-Z34.93, Z39.0) to prevent inappropriate authorization.