Local Coverage Article Billing and Coding

Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999

A55062

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Contractor Information

Article Information

General Information

Article ID
A55062
Article Title
Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2015
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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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.

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CMS National Coverage Policy

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Article Guidance

Article Text

Providers are aware that Medicare does not allow payment for contraceptive devices or medication. For this reason the service, 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.

Noridian 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 or who wish to preserve fertility. Noridian 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.

Acceptable CPT Code for Billing IUD Insertion

CPT DESCRIPTION
58999 UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NON-OBSTETRICAL)

Acceptable ICD-10-CM Codes for Billing IUD Insertion

ICD-10-CM Codes Description
N85.00 ENDOMETRIAL HYPERPLASIA, unspecified
N85.01 SIMPLE ENDOMETRIAL HYPERPLASIA WITHOUT ATYPIA

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

Effective Immediately

Coding Information

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

58999

Group 1 Codes

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CPT/HCPCS Modifiers

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ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N85.00
N85.01

Group 1 Codes

N/A

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

N/A

Additional ICD-10 Information

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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.

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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.

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Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2015 R2

Converted to Billing and Coding article type only. No changes to article content.

10/01/2015 R1

Typographical error - duplication of the word 'are'.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
05/08/2020 10/01/2015 - N/A Currently in Effect You are here
01/07/2019 10/01/2015 - N/A Superseded View
05/17/2016 10/01/2015 - N/A Superseded View

Keywords

  • IUD
  • Hormone-Eluting
  • Endometrial
  • Hyperplasia
  • 58999