Wiki United Healthcare Ablation 58563

[jnvollmar@gmail.com]

We are having issues getting CPT 58563 paid by UHC. The denial we are receiving is not medically necessary. Is anyone else having this issue or know if UHC is requiring proof of endo bx or trial of hormonal therapy prior to the ablation? I have reached out to UHC several times and no one can give me a clear answer as to what they are needing to show proof of medical necessity. Thanks for any help!

 

[csperoni]

A quick google search led me here:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/abnormal-uterine-bleeding-uterine-fibroids.pdf

However, I did not see the exact InterQual document they referenced. I only see that it's appropriate for "abnormal uterine bleeding in pre-menopausal patients" so you may want to check your primary ICD10.

 

[jnvollmar@gmail.com]

I believe our primary dx code is an appropriate dx code. I have searched high and low in that policy, but I cannot find anything that is black and white.

 

[lesliecoleman]

I am also having the same issue. I have reached out to UHC rep with no response....