Treatment of abnormal uterine bleeding with intrauterine device (hormone-eluting)

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.

Note: 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.