Laparoscopic, Percutaneous and Transcervical Techniques for Uterine Fibroid Myolysis

This policy covers laparoscopic, percutaneous, and transcervical uterine fibroid myolysis performed with ultrasound‑guided radiofrequency ablation (e.g., Acessa®, Sonata®) for symptomatic uterine fibroids causing heavy menstrual bleeding (including profuse bleeding >8 days or anemia), pelvic pain or pressure, urinary frequency, or other leiomyoma‑related symptoms in patients seeking uterine‑sparing treatment. Coverage is limited to ultrasound‑guided RFA techniques (Sonata has specific 510(k) clearances); other myolysis modalities (laser, bipolar, cryo, MRI‑guided) are considered experimental/not covered, and the evidence has limited long‑term follow‑up with variable reintervention rates while hysterectomy/myomectomy remain the criterion standard.

"Ultrasound-guided radiofrequency ablation (e."

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