N84.0 — Polyp of corpus uteri
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Submit CPT code 58999 on the claim for the IUD insertion.
- Use ICD-10 code N84.0 or codes N85.00–N85.02 on the claim to indicate endometrial hyperplasia.
- Enter the phrase "hormone IUD" in the comment/narrative field of the CMS-1500 claim form or the equivalent electronic claim field.
- Refills based upon documentation in cycle sheets.
Key Coverage Criteria
- Insertion of a hormone-containing intrauterine device (IUD) to treat endometrial hyperplasia in patients with abnormal uterine bleeding who are unable to tolerate oral megestrol or are at high risk for complications of oral megestrol.
- N98.1: Hyperstimulation of ovaries
- N99.83: Residual ovary syndrome
- Benign neoplasm and neoplasm of uncertain behavior of pituitary gland and craniopharyngeal duct (D35.2 - D35.3; D44.3 - D44.4)
- Neoplasm of uncertain behavior of female genital organs (D39.0 - D39.2)
- Neoplasm of uncertain behavior of other and unspecified male genital organs (D40.8 - D40.9)
4 Active Policies
CIGNA-0013 — Endometrial Ablation - (0013)
AETNA-CPB-0327 — Infertility
ANTHEM-CG-MED-84 — CG-MED-84 Non-Obstetric Gynecologic Duplex Ultrasonography of the Abdomen and Pelvis in the Outpatient Setting
A53043 — Billing and Coding: Endometrial Hyperplasia Treatment
Related Codes
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