LCD Reference Article Billing and Coding Article

Billing and Coding: Endometrial Hyperplasia Treatment

A53043

Expand All | Collapse All
Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website.
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A53043
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Endometrial Hyperplasia Treatment
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
07/01/2026
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.

Current Dental Terminology © 2025 American Dental Association. All rights reserved.

Copyright © 2026, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at ub04@aha.org or 312‐422‐3366.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act, §1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Article Guidance

Article Text

Providers are aware that Medicare does not allow payment for contraceptive devices or medication. For this reason, the service CPT® 58300, insertion of intrauterine device (IUD) has an "N" status in the Medicare Physician Fee Schedule, which means the service cannot be covered when billed to Medicare and will auto-deny.

Palmetto GBA is aware that insertion of a progestin-containing intrauterine device (IUD) is an alternative method of managing endometrial hyperplasia in patients who are not reasonable surgical candidates, are unable to tolerate oral progestin medications, are at high risk for complications or who wish to preserve fertility.

Palmetto GBA has determined that the use of a progestin containing IUD may be approved for use in the Medicare beneficiary who presents with endometrial hyperplasia without atypia.

Since the CPT® code for IUD insertion will be auto-denied, providers should bill this service using CPT® 58999 and an appropriate diagnosis for endometrial hyperplasia, including the product description "hormone IUD for endometrial hyperplasia" in Item 19 of the CMS-1500 form or the electronic equivalent claim field.

The medical record must clearly document the specific clinical circumstances evidencing this medical necessity.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(5 Codes)
Group 1 Paragraph

Dual diagnosis required. Must bill Group 2 diagnosis with any of the diagnosis codes in Group 1.

Group 1 Codes
Code Description
N84.0 Polyp of corpus uteri
N92.0 Excessive and frequent menstruation with regular cycle
N92.1 Excessive and frequent menstruation with irregular cycle
N92.4 Excessive bleeding in the premenopausal period
N95.0 Postmenopausal bleeding

Group 2

(2 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
Code Description
N85.01 Benign endometrial hyperplasia
N85.02* Endometrial intraepithelial neoplasia [EIN]
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Codes listed with an asterisk (*) are only to be used if beneficiary is not a surgical candidate.

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
07/01/2026 R8

Revised Article Text to align with other A/B MACs. Under Group 1: Paragraph added “Dual diagnosis required. Must bill Group 2 diagnosis with any of the diagnosis codes in Group 1.” Under Group 1: Codes N85.00 was deleted; N92.0, N92.1, N92.4, and N95.0 were added; and N85.01 and N85.02 were moved to the new Group 2: Codes. Under Group 2: Medical Necessity ICD-10-CM Codes Asterisk Explanation added “Codes listed with an asterisk (*) are only to be used if beneficiary is not a surgical candidate”.

01/01/2023 R7

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 58999. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/23.

12/03/2020 R6

Under CMS National Coverage Policy added descriptions to the regulations. Under Article Text added N84.0 to second bullet point to read “ICD-10 codes N84.0 or N85.00-N85.02”. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added N84.0.

10/31/2019 R5

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Under CMS National Coverage Policy added regulations. Formatting, punctuation and typographical errors were corrected throughout the article.

10/03/2019 R4

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles.

02/26/2018 R3 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
03/10/2016 R2 Under Article Text in the first paragraph added verbiage to the first sentence for clarification. In the second sentence deleted “Therefore”. In the first bullet of the second paragraph added (nonobstetrical) and in the third bullet added “…of the CMS-1500 claim form or the equivalent electronic claim field.”
10/01/2015 R1 Under Associated Documents, subtitle Statutory Requirements, added Title XVIII of the Social Security Act 1862 (a)(1)(A) and Title XVIII of the Social Security Act 1833 (e).
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
N/A
Related National Coverage Documents
NCDs
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
06/19/2026 07/01/2026 - N/A Currently in Effect You are here
01/10/2023 01/01/2023 - 06/30/2026 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A