Chronic Pelvic Pain and Endometriosis (CPB 0754, reviewed 2026-10-16)
Effective date
Not stated in the notice
Identified
Oct 17, 2026
Summary
Aetna considers cannabinoids, hypnotherapy, hypogastric plexus neurolysis for chronic pelvic pain associated with endometriosis, neuromodulation (dorsal root ganglion stimulation, posterior tibial nerve stimulation, sacral nerve stimulation, and spinal cord stimulation), peritoneal excision (stripping) for endometriosis, and superior hypogastric plexus block with traditional pharmacological treatments experimental, investigational, or unproven. Uterine nerve ablation, laparoscopic uterine nerve ablation and presacral neurectomy are also considered experimental, investigational, or unproven for chronic pelvic pain or other indications. The policy lists related CPT and HCPCS codes, and endometriosis ICD-10 codes, as not covered for the indications it names.
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01Billing team: Do not bill the services this policy considers experimental, investigational, or unproven as covered for chronic pelvic pain or endometriosis.
02Claims for listed codes such as 64517 (superior hypogastric plexus injection) and 63650 (neurostimulator electrode array) are not covered for the indications the policy lists.
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