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In July, Harvard Pilgrim began requiring prior authorization for select surgical procedures, including total hysterectomy. A review of Harvard Pilgrim’s policy on prior authorization requirements for hysterectomy revealed that several coding updates were required to be consistent with the policy’s intent.
Effective Sept. 24, 2015, Harvard Pilgrim will not require prior authorization for cancer-related hysterectomies. As a result, the following codes will no longer require prior authorization:
- 58200 – Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)
- 58210 – Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)
- 58548 – Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed
Additionally, effective Sept. 24, 2015, Harvard Pilgrim will require prior authorization for the following codes:
- 58150 — Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);
- 58152 — Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (e.g., Marshall-Marchetti-Krantz, Burch)
For more information, please refer to the updated Hysterectomy Prior Authorization Medical Review Criteria.
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