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.

Learn more

• Applicable Community Plan policies
• Current prior authorization requirements

Questions?

Contact 888-362-3368

CPT^® is a registered trademark of the American Medical Association.  

PCA-1-21-02602-VC-News