Pennsylvania and New Jersey: Hysterectomy prior authorization criteria change

Effective Nov. 1, 2021, UnitedHealthcare Community Plans (Medicaid, Long-Term Care) in New Jersey and Pennsylvania will have a criteria change to an existing hysterectomy prior authorization.

  • CPT® code 58573 – Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 grams; with removal of tube(s) and/or ovary(s)

This CPT code 58573 will require prior authorization regardless of the diagnosis code submitted.

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