[

Providers are reminded that endometrial ablation, with or without hysteroscopic guidance, is covered for premenopausal women with menorrhagia (excessive menstrual flow) and a benign endometrium who are unresponsive to, or have a contraindication to, hormone therapy and would otherwise be considered candidates for hysterectomy.

Endometrial ablation is a procedure used to treat menorrhagia in premenopausal women who have completed childbearing. During the procedure, an energy source is used to ablate (destroy) endometrial tissue to reduce menstrual flow. It is an alternative to hysterectomy that is used when other treatments, such as hormone therapy, have either failed to reduce menstrual flow or cannot be taken.

Endometrial ablation is contraindicated in individuals who have:

• confirmed pregnancy or desire for a future pregnancy;
• history of endometrial cancer or precancerous histology;
• active infection (genital or urinary tract) at the time of the procedure;
• active pelvic inflammatory disease;
• intrauterine device (IUD) in place at the time of the procedure;
• any anatomic or pathologic condition (e.g., history of previous classical caesarean sections or transmural myomectomy) in which weakness of the myometrium could exist.

For more information, please visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select the Commercial or Medicare Advantage tab from the top of the page, depending on the version of the policy you'd like to view. Then type the policy name or number in the Search field:

• Commercial: #11.06.05c: Endometrial Ablation
• Medicare Advantage: #MA11.065a: Endometrial Ablation

You can also get to our Medical Policy Portal through the NaviNet^® web portal by selecting the Reference Tools transaction, then Medical Policy.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

]