Endometrial Ablation

This policy covers endometrial ablation (and the LNG 52 mg levonorgestrel IUD as a non‑surgical alternative) to treat premenopausal abnormal uterine bleeding—including menorrhagia unresponsive to medical therapy and residual menstrual bleeding in transgender men—in patients who have completed childbearing and do not desire future fertility. Major limitations/requirements: the procedure must use an FDA‑approved device, is contraindicated in pregnancy, presence of an IUD, active pelvic infection, untreated bleeding disorders, endometrial hyperplasia or cancer, postmenopausal patients, or when structural uterine pathology requires transmural surgery; photodynamic ablation and unsupported indications are not covered.

"Treatment of premenopausal abnormal uterine bleeding"

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