Abnormal Uterine Bleeding and Uterine Fibroids – Commercial and Individual Exchange Medical Policyopen_in_new

This policy covers treatment of abnormal uterine bleeding and uterine fibroids, including endometrial ablation (e.g., hysteroscopic ablation CPT 58563), levonorgestrel-releasing IUDs (Mirena, Skyla, Liletta, Kyleena), uterine artery embolization (CPT 37243), MR-guided focused ultrasound (CPT 0071T/0072T), and related interventional procedures. It applies mainly to premenopausal individuals with AUB, women with menorrhagia, and patients with symptomatic fibroids (including postpartum/post‑hysterectomy bleeding and uterine AVM), but coverage requires meeting InterQual medical necessity criteria and member benefit limits, endometrial biopsy to exclude malignancy prior to some procedures; MRgFUS is considered unproven and UAE is not covered for fertility preservation.

"Endometrial ablation is proven and medically necessary for treating abnormal uterine bleeding in premenopausal individuals."