Hysterectomy – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers hysterectomy as medically necessary for BRCA1/BRCA2 carriers and for other indications that meet InterQual® hysterectomy criteria (e.g., fibroids, endometriosis, prolapse, abnormal bleeding, or chronic pelvic pain after failed conservative therapy); prophylactic hysterectomy at the time of RRSO is controversial and must be individualized rather than routinely recommended. Coverage requires the member’s specific benefit plan allowance, documentation meeting InterQual®/medical-record review (genetic test results, prior treatments, counseling/consent, fertility considerations), and compliance with FDA morcellator contraindications; services not meeting InterQual® or plan criteria are not supported.

"Benign conditions that might be treated with a hysterectomy include endometriosis."

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