dysfunctional uterine bleeding & uterine fibroids - Health Plan of ...
dysfunctional uterine bleeding & uterine fibroids - Health Plan of ...
dysfunctional uterine bleeding & uterine fibroids - Health Plan of ...
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WOU001<br />
remain unknown. Further long-term studies on larger samples published in peerr-eviewed medical<br />
literature are necessary to demonstrate the safety and efficacy <strong>of</strong> this technology.<br />
Magnetic resonance imaging (MRI)-guided focused ultrasound ablation (FUA) is not medically<br />
necessary for treating <strong>uterine</strong> <strong>fibroids</strong>.<br />
Further studies are needed to determine the long-term efficacy <strong>of</strong> this procedure and to evaluate the<br />
efficacy and safety <strong>of</strong> this procedure relative to other treatments for <strong>uterine</strong> <strong>fibroids</strong>. See the Benefit<br />
Considerations section for potential coverage <strong>of</strong> unproven services.<br />
Levonorgestrel-Releasing Intra<strong>uterine</strong> Device<br />
The levonorgestrel-releasing intra<strong>uterine</strong> device (LNG-IUD) is medically necessary for treating<br />
<strong>dysfunctional</strong> <strong>uterine</strong> <strong>bleeding</strong> in premenopausal women.<br />
Uterine Artery Embolization<br />
Uterine artery embolization (UAE) is medically necessary for treating confirmed, symptomatic<br />
<strong>uterine</strong> <strong>fibroids</strong>.<br />
Uterine artery embolization (UAE) is not medically necessary for women with symptomatic<br />
<strong>uterine</strong> <strong>fibroids</strong> who wish to preserve their childbearing potential.<br />
The effects <strong>of</strong> UAE on ovarian and <strong>uterine</strong> function and on fertility are relatively unknown. Further<br />
studies <strong>of</strong> safety and/or efficacy in published, peer-reviewed medical literature are necessary.<br />
Medicare does not have a National Coverage Determination or a Local Coverage Determination for<br />
Nevada for Uterine Bleeding and Uterine Fibroids.<br />
Medicare does have a National Coverage Determination (NCD) for Therapeutic Embolization. The<br />
NCD is as follows:<br />
Therapeutic embolization is covered when done for hemorrhage, and for other conditions amenable<br />
to treatment by the procedure, when reasonable and necessary for the individual patient.<br />
Renal embolization for the treatment <strong>of</strong> renal adenocarcinoma continues to be covered, effective<br />
December 15, 1978, as one type <strong>of</strong> therapeutic embolization, to:<br />
1. Reduce tumor vascularity preoperatively, or<br />
2. Reduce tumor bulk in inoperable cases, or<br />
3. Palliate specific symptoms.<br />
See NCD for Therapeutic Embolization (20.28) at:<br />
http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=20.28&ncd_version=1&basket=ncd:20.28:1:Thera<br />
peutic+Embolization .<br />
There is no Local Coverage Determination for Nevada for Therapeutic Embolization. (Accessed June,<br />
2010)<br />
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