Tubal Sterilization

Aetna considers Falope ring, Filshie and Hulka‑Clemens clips, partial salpingectomy (e.g., Pomeroy, Parkland) and total/bilateral salpingectomy medically necessary for tubal ligation sterilization. Hysteroscopic/transcervical methods (e.g., Essure), FemBloc (Adiana discontinued) are deemed experimental/investigational and not covered, and CPT codes 0567T and 58565 and HCPCS A4264 are not covered for these indications.

"Laparoscopy with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) when indicated (CPT 58661)"

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