Corporate

April 10, 2018

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.

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 form or the electronic equivalent must state:
    • Hormone IUD for endometrial hyperplasia
  • Acceptable ICD10 Codes
    • N85.00 – Endometrial Hyperplasia, unspecified
    • N85.01 – Simple Endometrial Hyperplasia without Atypia

The medical record must clearly document the specific clinical circumstances evidencing this medical necessity.

This will be effective for claims submitted with dates of service on or after  17 April 2018.

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