Prior Auth Required

58572 - Laparoscopy, surgical, with total Prior Authorization Required Medical Necessity Submit History and Physical

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceLaparoscopy, surgical, with total Prior Authorization Required Medical Necessity Submit History and Physical
Procedure / Service Description

hysterectomy, for uterus 250 g or less; with documentation of medical necessity, - removal of tube(s) and/or ovary(s) operative report. No review required for gynecologic malignant conditions. 58572 Laparoscopy, surgical, with total Prior Authorization Required Medical Necessity Submit History and Physical, hysterectomy, for uterus greater than 250 documentation of medical necessity, g; operative report. No review required for

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.