TL;DR: Aetna, a CVS Health company, modified CPB 0304 governing fibroid treatment coverage, effective September 26, 2025. Here's what billing teams need to know before submitting claims.
This update to the Aetna fibroid treatment coverage policy affects claims billed under CPT codes 37243, 58580, and 58674 for minimally invasive procedures, as well as the full range of myomectomy and hysterectomy codes where power morcellation is involved. The real issue here is the power morcellation carve-outs — they're narrow, the documentation requirements are strict, and denials are easy to trigger if your clinical notes don't align exactly with the criteria.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Fibroid Treatment — CPB 0304 |
| Policy Code | CPB 0304 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | OB/GYN, Interventional Radiology, Minimally Invasive Surgery, Women's Health |
| Key Action | Audit documentation for power morcellation cases to confirm one of three narrow exception criteria is met before billing CPT 58140–58146 or any hysterectomy code with morcellation. |
Aetna Fibroid Treatment Coverage Criteria and Medical Necessity Requirements 2025
The Aetna fibroid treatment coverage policy under CPB 0304 covers three minimally invasive approaches as alternatives to hysterectomy or myomectomy. These are radiofrequency ablation (open, laparoscopic via the Acessa System, or transcervical via the Sonata System) and transcatheter uterine artery embolization (UAE). Both meet medical necessity under this policy.
To get coverage, the member must have at least one persistent symptom directly caused by uterine fibroids. Qualifying symptoms include:
| # | Covered Indication |
|---|---|
| 1 | Excessive menstrual bleeding (menorrhagia) |
| 2 | Bulk-related pelvic pain, pressure, or discomfort |
| 3 | Urinary symptoms from ureteral or bladder compression |
| 4 | Dyspareunia |
The word "persistent" matters here. Aetna wants documentation that symptoms continue despite conservative management. If your chart notes only describe a single encounter or initial presentation, expect a claim denial. Your clinical documentation should show an ongoing pattern.
For uterine artery embolization billing, the covered approach includes polyethylene glycol microspheres (HydroPearl) and tris-acryl gelatin microspheres (Embospheres). CPT 37243 covers the vascular embolization procedure, inclusive of radiological supervision and interpretation. Don't unbundle imaging separately from 37243 — it won't survive a claim audit.
For laparoscopic radiofrequency ablation, bill CPT 58674. For transcervical ablation (Sonata System), bill CPT 58580. Both are covered when medical necessity criteria are met. Prior authorization requirements vary by plan, so check member-level benefits before scheduling. Given the financial exposure on these cases — RFA and UAE are high-cost procedures — confirm prior auth before the procedure date, not after.
Aetna Power Morcellation Exclusions and Non-Covered Indications
This is where the policy gets complicated. Aetna considers myomectomy and hysterectomy using power morcellation experimental, investigational, or unproven for uterine fibroids as a general rule. The safety and effectiveness have not been established to Aetna's standard. That means the default position is non-coverage.
Three narrow exceptions exist. Power morcellation is covered only when:
Exception 1 — Fertility preservation: The member is premenopausal, wants to maintain fertility, and has no risk factors for uterine sarcoma. Risk factors that disqualify include two or more years of tamoxifen therapy, history of pelvic irradiation, childhood retinoblastoma, Lynch syndrome, or hereditary leiomyomatosis and renal cell carcinoma syndrome.
Exception 2 — Large uterus, difficult vaginal hysterectomy: The member is premenopausal, has a clinical indication for hysterectomy, has no uterine sarcoma risk factors, and a vaginal hysterectomy is technically difficult due to uterine size.
Exception 3 — High-risk comorbidities: The member has comorbidities — cardiovascular, renal, hepatic, pulmonary, endocrine, or morbid obesity — where alternative procedures (hysterectomy without morcellation, RFA, UAE) carry unacceptable surgical risk.
All three exceptions apply only to women without known or strongly suspected uterine cancer. And in every case, the member must be informed of the risks of morcellation spreading unsuspected cancerous tissue, and documentation of that informed consent must be in the chart.
The real issue here is that these exceptions are easy to claim and hard to document properly. If your pre-auth request doesn't specify which exception applies, or your operative note doesn't address sarcoma risk factors, Aetna has clear grounds to deny on medical necessity. Get specific in your documentation before you bill.
If you're handling cases at the edge of these criteria — particularly the comorbidity exception — talk to your compliance officer before the September 26, 2025 effective date. The line between "unacceptable surgical risk" and a routine high-risk patient is a judgment call, and you want a defensible position documented before a claim goes out.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Radiofrequency ablation (laparoscopic, e.g., Acessa System) for symptomatic fibroids | Covered | CPT 58674 | Requires persistent symptom documentation; prior auth recommended |
| Transcervical RFA (e.g., Sonata System) for symptomatic fibroids | Covered | CPT 58580 | Same symptom criteria; confirm plan-level prior auth |
| Uterine artery embolization with HydroPearl or Embospheres | Covered | CPT 37243 | Inclusive of imaging supervision; do not unbundle |
| Power morcellation — premenopausal, fertility preservation, no sarcoma risk factors | Covered (exception) | CPT 58140–58146 | Must document absence of all sarcoma risk factors; informed consent required |
| Power morcellation — large uterus, difficult vaginal hysterectomy, no sarcoma risk | Covered (exception) | CPT 58150–58210 range | Premenopausal only; must document technical difficulty |
| Power morcellation — high-risk comorbidities, alternatives pose unacceptable risk | Covered (exception) | CPT 58140–58210 range | Document why each alternative is contraindicated |
| Power morcellation — general fibroid removal outside exception criteria | Not Covered / Experimental | CPT 58140–58210 range | Default position; denial expected without exception documentation |
| Myomectomy or hysterectomy with power morcellation in known/suspected uterine cancer | Not Covered | CPT 58140–58210 range | Hard exclusion — no exceptions |
Aetna Fibroid Treatment Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit all pending power morcellation cases before September 26, 2025. Identify every scheduled or in-progress case where a surgeon plans to use morcellation. For each one, confirm which of the three exceptions applies and that the chart supports it. A denial on a complex surgical case is expensive to fight. |
| 2 | Update your pre-auth templates to include exception documentation. Generic prior auth requests for myomectomy or hysterectomy won't cut it here. Your template should include a field for the specific exception being claimed, supporting clinical detail on sarcoma risk factors, and documentation of informed consent on morcellation risks. |
| 3 | For CPT 37243 (UAE), confirm you're not unbundling imaging. The code is inclusive of all radiological supervision and interpretation. Billing a separate radiology code alongside 37243 is a claim error and a common reason for post-payment audits. |
| 4 | For CPT 58580 and 58674, document symptom persistence explicitly. A single clinical note describing fibroids isn't enough. Your documentation should show the duration of symptoms, prior treatments tried, and the specific qualifying symptom — menorrhagia, pelvic pressure, urinary compression, or dyspareunia. |
| 5 | Verify prior authorization requirements by member plan before scheduling. This coverage policy sets the medical necessity floor, but individual Aetna plan contracts layer additional prior auth requirements on top. Reimbursement for RFA and UAE is significant enough that a missing prior auth is a costly error. |
| 6 | Train your surgical schedulers on the sarcoma risk factor checklist. The exclusion criteria for power morcellation — tamoxifen history, pelvic irradiation history, retinoblastoma, Lynch syndrome, hereditary leiomyomatosis — aren't things a coder discovers in a chart after the fact. These need to be screened at the pre-surgical evaluation. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Fibroid Treatment Under CPB 0304
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 37243 | CPT | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation (UAE) |
| 58580 | CPT | Transcervical ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring |
| 58674 | CPT | Laparoscopy, surgical, ablation of uterine fibroid(s) including intraoperative ultrasound guidance and monitoring |
Not Covered / Experimental CPT Codes (Power Morcellation — Default Position)
These myomectomy and hysterectomy codes are not covered when billed with power morcellation outside the three narrow exception criteria. Coverage applies only when one of the documented exceptions is met.
| Code | Type | Description | Reason |
|---|---|---|---|
| 58140 | CPT | Myomectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58141 | CPT | Myomectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58142 | CPT | Myomectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58143 | CPT | Myomectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58144 | CPT | Myomectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58145 | CPT | Myomectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58146 | CPT | Myomectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58150 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58151 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58152 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58153 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58154 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58155 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58156 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58157 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58158 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58159 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58160 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58161 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58162 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58163 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58164 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58165 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58166 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58167 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58168 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58169 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58170 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58171 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58172 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58173 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58174 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58175 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58176 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58177 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58178 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58179 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58180 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58181 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58182 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58183 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58184 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58185 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58186 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58187 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58188 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58189 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58190 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58191 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58192 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58193 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58194 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58195 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58196 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58197 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58198 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58199 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58200 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58201 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58202 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58203 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58204 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58205 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58206 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58207 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58208 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58209 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
| 58210 | CPT | Hysterectomy | Experimental/not covered for power morcellation outside exception criteria |
The full policy lists 184 CPT codes. The data provided above includes codes through CPT 58210. See the full CPB 0304 policy at the Aetna source for the complete code set.
Key ICD-10-CM Diagnosis Codes
The full policy references 163 ICD-10-CM codes. The policy data provided includes the first 80 codes in this extract. See the complete CPB 0304 Aetna fibroid treatment billing guidelines at the source policy for the full ICD-10 list. Work with your coding team to confirm the correct fibroid diagnosis code — D25.x (leiomyoma of uterus) codes are the expected anchor diagnoses for medical necessity alignment.
Get the Full Picture for CPT 58140
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.