On April 5, 2021, Blue Cross and Blue Shield of Minnesota (Blue Cross) implemented a new medical policy, IV-168: Hysterectomy for Non-Malignant Conditions, for fully and self-insured commercial members.
Summary
As an advocate for our members’ health and health care dollars, Blue Cross is dedicated to ensuring that members receive medically necessary care at the right time and place.
While national guidelines support the need for non-malignant hysterectomy when there has been a lack of response to conservative treatments, overutilization of this procedure is common in the United States, where more than 400,000 hysterectomies are performed annually, according to research published in the American Journal of Obstetrics and Gynecology.
Blue Cross is committed to ensuring that non-malignant hysterectomies are supported by medical necessity guidelines.
The purpose of this initiative is to more effectively monitor the quality of care for Blue Cross members by ensuring all non-malignant hysterectomies are appropriate and medically necessary. Non-malignant hysterectomies will be reviewed according to standards for medical necessity as published in the medical policy.
Beginning with April 5, 2021 dates of service, reimbursement will be recouped for hysterectomy surgeries for non-malignant conditions that do not meet the medical necessity criteria outlined in the new medical policy.
Impacted procedures
Procedure: Hysterectomy Surgery for Non-Malignant Conditions
CPT Codes:
58150
58152
58180
58260
58262-58263
58267
58270
58275
58280
58290-58294
58541-58544
58550
58552-58554
58570-58573
59525
Medical policy effective 4/5/21 (Commercial Fully Insured and Self-Insured)
- Non-malignant hysterectomies must meet medical necessity criteria defined in an upcoming medical policy to qualify for reimbursement.
- Blue Cross will review outpatient non-malignant hysterectomy claims to determine if the services provided were in accordance with this new medical policy.
- Payment for procedures that do not meet medical necessity will be recouped beginning with dates of service on or after April 5, 2021.
More information
Provider bulletin
A provider bulletin (PDF) pertaining to this policy was posted on February 1, 2021. Updates and reminders related to this change will be included in future provider communication materials.