Endometrial Ablation - (0013)

Endometrial ablation is covered as an alternative to hysterectomy for menorrhagia/excessive anovulatory bleeding and for residual menstrual bleeding after androgen therapy in transgender men, but is not covered for other indications (including endometrial/cervical cancer or precancers, hyperplasia, postmenopausal women, fertility preservation, photodynamic/chemoablation, and specific excluded ICD‑10 diagnoses such as submucous/intramural leiomyomas, uterine/cervical polyps, intrauterine synechiae, etc.). Coverage requires documentation excluding remediable pathology/malignancy (endometrial sampling ± D&C and imaging/hysteroscopy), failure/intolerance/contraindication of ≥3 months medical/hormonal therapy, removal of IUD, completion of childbearing, adherence to device uterine size limits (uterine length <13 cm/≈<12 weeks and AP width <7 cm), and appropriate coding/documentation.

"Endometrial ablation is considered medically necessary as an alternative to hysterectomy for the treatment of menorrhagia or excessive anovulatory bleeding."