CurrentOscar HealthPolicy N/A

Endometrial (uterine) ablation reimbursement

This document governs Oscar Health's reimbursement policy for endometrial/uterine ablation procedures and specifies coding and diagnosis requirements for claims; it affects providers submitting claims to Oscar for these procedures.

Policy Summary

PayerOscar Health

PolicyEndometrial (uterine) ablation reimbursement

Policy CodePolicy N/A

Change TypeRevised coverage stance

Effective DateN/A

Next Review DateN/A

Key ActionInclude one of the allowed CPT codes and an allowed diagnosis code on the claim to receive reimbursement for endometrial ablation.

SourceLink

POLICY UPDATE CHANGES

Oscar will begin reimbursing for uterine ablation procedures when clinically appropriate rather than routinely denying them.

3listed CPT codes

2listed diagnosis code groups

09/30/2022publication history

Reimbursement Criteria

Reimbursement criteria

Endometrial ablation procedures are reimbursed only when the claim includes both an allowed CPT code and an allowed diagnosis code from the lists below.

ALL of the following

Claim includes one of the specified CPT codes: 0404T, 0071T, or 0072T.
Claim includes an associated diagnosis code from the provided list: N93 (Abnormal uterine and vaginal bleeding, unspecified) or D25 (Leiomyoma of uterus).

Reimbursement will be denied if either an allowed CPT code or an allowed diagnosis code from the lists is not present on the claim.

Permitted Procedure and Diagnosis Codes

Allowed CPT Codes for endometrial ablationCPTCovered

0404T
0071T
0072T

Policy Summary

PayerOscar Health

PolicyEndometrial (uterine) ablation reimbursement

Policy CodePolicy N/A

Change TypeRevised coverage stance

Effective DateN/A

Next Review DateN/A

Key ActionInclude one of the allowed CPT codes and an allowed diagnosis code on the claim to receive reimbursement for endometrial ablation.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Key Definitions

Clinically appropriate (implicit) — reimbursement conditions

DefinitionReimbursement will be provided when uterine (endometrial) ablation is clinically appropriate and claims include the required coding.

Claim coding requirementClaim must include one of the allowed CPT codes: 0404T, 0071T, or 0072T.

Associated diagnosis requirementClaim must include an associated diagnosis code from the policy list (examples: N93 — Abnormal uterine and vaginal bleeding, D25 — Leiomyoma of uterus).

Operational changeOscar will begin reimbursing for uterine ablation procedures when clinically appropriate rather than routinely denying them.

Provider actionEnsure both an allowed CPT code and an allowed diagnosis code are submitted on the claim to receive reimbursement.

OpenPayer

Endometrial (uterine) ablation reimbursement

Reimbursement Criteria

Permitted Procedure and Diagnosis Codes

Claims Documentation & Billing Requirements

Key Definitions

N93	Abnormal uterine and vaginal bleeding, unspecified
D25	Leiomyoma of uterus