RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Treatment of Abnormal Uterine Bleeding with Intrauterine Device (Hormone-Eluting)

A59619

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A59619
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Treatment of Abnormal Uterine Bleeding with Intrauterine Device (Hormone-Eluting)
Article Type
Billing and Coding
Original Effective Date
12/28/2023
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
12/04/2025

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text


This Billing and Coding Article contains coding and other guidelines that reflect proper billing for insertion of an Intrauterine Device (IUD) (Hormone-Eluting) for the treatment of abnormal uterine bleeding.

Coding Guidance

Chronic abnormal uterine bleeding (AUB) describes irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy for at least six months. The following conditions causing AUB can be treated with levonorgestrel-releasing intrauterine device (Hormone-Eluting IUD) depending on the patient's desire for fertility, medical comorbidities, symptoms, and distortion of the uterine cavity: Leiomyomas (fibroids), malignancy or endometrial hyperplasia, and iatrogenic causes of AUB.

First Coast is aware that the insertion of a progestin-containing IUD is an alternative method of managing endometrial hyperplasia for patients who wish to preserve fertility or are not surgical candidates. First Coast has determined that the use of a progestin-containing IUD may be approved for the use in the Medicare beneficiary with endometrial hyperplasia without atypia.

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.

The CPT code for IUD insertion (58300) will be auto-denied, therefore, providers should bill this service using CPT code 58999, unlisted procedure, female genital system (non-obstetrical), with an appropriate diagnosis for endometrial hyperplasia. Providers must also include the product description “hormone IUD for endometrial hyperplasia” in item 19 of the CMS-1500 form or electronic equivalent.

The diagnosis code(s) must best describe the patient's condition for which the service was performed.

Notice: It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. The medical record must clearly document the specific clinical circumstances evidencing this medical necessity.

Response To Comments

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1
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Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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

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ICD-10-PCS Codes

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Group 1 Codes

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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.

Code Description

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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.

Code Description

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Other Coding Information

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Group 1 Codes

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

Revision History Date Revision History Number Revision History Explanation
12/04/2025 R1

Article retired effective for dates of service on and after 12/04/2025. Providers should refer to the First Coast Service Options FAQs for billing information on this topic.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
NCDs
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SAD Process URL 1
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SAD Process URL 2
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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
12/04/2025 12/28/2023 - 12/04/2025 Retired You are here
12/21/2023 12/28/2023 - N/A Superseded View

Keywords

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