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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2017

Update to StrideSM (HMO) Medicare Advantage Hysterectomy Criteria


Harvard Pilgrim has updated our StrideSM (HMO) Medicare Advantage medical review criteria for hysterectomy procedures to include criteria for post-menopausal women with abnormal uterine bleeding.

With prior authorization, Harvard Pilgrim covers hysterectomy procedures (vaginal hysterectomy, radical hysterectomy, and hysterectomy with or without bilateral salpingo-oophorectomy) for members who meet the condition-specific criteria outlined in the policy.

Effectively immediately, Harvard Pilgrim covers hysterectomy procedures for post-menopausal women with abnormal uterine bleeding for whom both of the following apply:

  1. Have normal endometrium (no endometrial lesions), confirmed by any of the following within the past 3 months:
    • Endometrial biopsy and ultrasound
    • Hysteroscopy with directed biopsy
    • Dilation and curettage
  2. Used hormone treatment (three months of hormone replacement therapy for atrophy, or progestin for hypertrophy) unless contraindicated

For complete information, please refer to the updated StrideSM (HMO) Medicare Advantage Hysterectomy Medical Review Criteria.

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