Pelvic Denervation Procedures - (0368)

Presacral neurectomy (PSN) is covered as medically necessary as a last‑line alternative to hysterectomy for refractory midline dysmenorrhea or intractable midline pelvic pain after failure of medical and surgical treatments, while laparoscopic uterosacral nerve ablation (LUNA) is considered experimental/investigational and not covered for any indication. Claims require documentation of the refractory midline diagnosis and prior failed conservative therapies, an operative report clearly specifying PSN (not LUNA), and appropriate CPT/diagnosis codes (e.g., 58578 and/or 64999 when criteria are met) or they will be denied.

"Presacral neurectomy (PSN) is considered medically necessary as an alternative to hysterectomy when the available medical and surgical treatment options have failed to control refractory midline dy..."

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