Endometrial Cancer Screening, Diagnosis, and Prognosis

Aetna covers medically necessary endometrial sampling (e.g., endometrial biopsy with suction curette/Pipelle or Tao brush) for diagnostic evaluation of abnormal uterine bleeding when endometrial hyperplasia or carcinoma is suspected, for surveillance in women with Lynch syndrome, and sentinel lymph node mapping for pathologic staging, with listed CPT/HCPCS codes covered only if selection criteria are met. Aetna considers endometrial biopsy for routine screening and molecular/biomarker tests (circulating adiponectin/leptin and ratio, circulating and tissue microRNAs, circular RNAs, DNA methylation) experimental/investigational and not covered.

"ICD-10 diagnoses listed as 'covered if selection criteria are met' (examples listed in policy): C54."

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