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11.06.04k, Uterine Artery Embolization
Independence Blue Cross·PA · OB-GYN, Radiology, Vascular Surgery·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued Policy 11.06.04k on Uterine Artery Embolization (UAE) with no substantive changes to coverage criteria, medically necessary indications, contraindications, or experimental/investigational designations. The policy continues to cover UAE for symptomatic uterine fibroids and postpartum hemorrhage under specified clinical criteria, with no new billing code, documentation, or prior authorization requirements.
Action Required
No immediate action required. This is a reissue with no changes to policy coverage, criteria, or billing requirements. Billing team should verify that current claim submission practices align with the existing coverage criteria: (1) symptomatic uterine fibroids meeting specified clinical indicators OR asymptomatic abdominally palpable/significantly enlarged fibroids, OR (2) postpartum uterine hemorrhage. Ensure claims include appropriate ICD-10 diagnosis codes (D25.0, D25.1, D25.2, D25.9 for fibroids; O72.0, O72.1, O72.2 for postpartum hemorrhage) and CPT codes 36245-36248 for catheter placement. Confirm that treatment for individuals desiring pregnancy, cervical ectopic pregnancy, or adenomyosis continues to be denied as experimental/investigational. No changes to prior authorization processes are required.