Radiofrequency ablation (The NovaSure Procedure, and the Minerva Endometrial Ablation System).

Microwave endometrial ablation (Microsulis Microwave Endometrial Ablation (MEA) System).

Electrosurgical ablation/electrocautery ablation (e.g., electric rollerball, resecting loop with electric current, triangular mesh with electrical current).

Cryoablation (freezing) (Her Option Cryoablation Therapy).Chemical ablation with trichloroacetic acid.

Note: The Pap smear should be up to date so not necessarily within the past year.Īetna considers hysteroscopic sterilization experimental and investigational when performed at the same time as radiofrequency endometrial ablation, as ablation has been shown to decrease the sucess rate of sterilization.Īetna considers endometrial ablation experimental and investigational for all other indications (e.g., post-menopausal bleeding) because its effectiveness for other indications has not been established.Īetna considers the following endometrial ablation approaches to be established for treatment of women who meet the selection criteria set forth above: Pap smear and gynecologic examination have excluded significant cervical disease.Structural abnormalities (fibroids, polyps) that require surgery or represent a contraindication to an ablation procedure have been excluded (this is almost always done by ultrasound in the past year) and.Endometrial sampling or D&C has been performed within the year prior to the procedure to exclude cancer, pre-cancer or hyperplasia, and the results of the histopathological report have been reviewed before the ablation procedure is scheduled (should be done in the past year) and.Note: Some plans exclude coverage of surgery for gender reassignment please check benefit plan descriptions and To stop residual menstrual bleeding after androgen treatment in a female to male transgender person who meet criteria for gonadectomy in CPB 0615 - Gender Affirming Surgery. Hormonal therapy or other pharmacotherapy įootnotes* Note: The degree of severity and persistence of the menorrhagia and the failure of prior treatment should be such that the member would otherwise be a candidate for a hysterectomy these alternative less invasive approaches should have been attempted in the past year or.Menorrhagia Footnotes* unresponsive to (or with a contraindication to) either: Aetna considers endometrial ablation medically necessary for women who meet all of the following selection criteria:

Ablation and weight gain 2017