Removal of Prior Authorization Requirements for Minimally Invasive Hysterectomy Procedures when Performed in an Outpatient Setting
Date: 10/04/19
Effective October 1, 2019, Superior HealthPlan will no longer require prior authorization for minimally invasive hysterectomies when performed in the outpatient setting for Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members.
Below is the listing of CPT codes included in this change to the prior authorization requirements.
CPT Codes | Description |
|---|---|
58260 | Vaginal hysterectomy, for uterus 250 g or less |
58262 | Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) |
58263 | Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele |
58267 | Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control |
58270 | Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele |
58275 | Vaginal hysterectomy, with total or partial vaginectomy |
58280 | Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele |
58285 | Vaginal hysterectomy, radical (Schauta type operation) |
58290 | Vaginal hysterectomy, for uterus greater than 250 g |
58291 | Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) |
58292 | Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele |
58293 | Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control |
58294 | Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele |
58541 | Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less |
58542 | Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) |
58543 | Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g |
58544 | Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) |
58548 | Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed |
58570 | Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less |
58571 | Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) |
58572 | Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g |
58573 | Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) |
58575 | Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed |
58550 | Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less |
58552 | Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) |
58553 | Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g |
58554 | Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) |
As a reminder, providers can determine which specific codes require prior authorization by visiting Superior’s Pre-Auth Needed tool.
If you have any questions regarding this information, you may contact your dedicated Account Manager or Provider Services at 1-877-391-5921.