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Corporate

April 10, 2018 - Revised 08.06.20

IUD (Hormone-Eluting) for Endometrial Hyperplasia – CPT code 58999

Currently, Medicare does not allow payment for CPT code 58300, insertion of intrauterine device (IUD) or contraceptive devices or medication.

After careful review by CGS Medical Directors, the insertion of a progestin-containing intrauterine device (IUD) is an alternative method for managing endometrial hyperplasia in patients who are not reasonable surgical candidates or who wish to preserve fertility. CGS has determined that the use of a progestin containing IUD may be approved for use in patients with endometrial hyperplasia without atypia. The medical record must clearly document the specific clinical circumstances evidencing this medical necessity.

CGS will cover this service ONLY in the following circumstances:

  • Use CPT code 58999 – unlisted procedure, female genital system (non-obstetrical)
  • Item 19 of the CMS-1500 claim form/ the Remarks section of the UB-04 claim form or electronic equivalent must state:
    • Hormone IUD for endometrial hyperplasia
  • Acceptable ICD-10 Codes
    • N85.01 – Simple Endometrial Hyperplasia without Atypia

Note: Reimbursement includes allowable for IUD and insertion of IUD.

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