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A hysterectomy is a limited benefit and only covered when medically necessary. 

Hysterectomies may be a covered benefit for the following:

  • The treatment of pathology (cancer, adenomyosis, fibroids, endometriosis, dysfunctional uterine bleeding)
  • The beneficiary is about to undergo or is undergoing tamoxifen therapy
  • The beneficiary has been diagnosed with hereditary non-polyposis colorectal cancer (HNPCC) or found to be a carrier of HNPCC-associated mutations

A hysterectomy is not a covered benefit when performed solely for purposes of sterilization and/or hygiene in the absence of pathology.

To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request. 

Cost Information