CMSNational Coverage Determination (NCD)

CMS Gravlee Jet Washer Form


Gravlee Jet Washer

Indications

(66858) Is the Gravlee Jet Washer being used to detect endometrial cancer in a patient exhibiting clinical symptoms or signs suggestive of endometrial disease, such as irregular or heavy vaginal bleeding? 

Contraindications

(66859) Is the Gravlee Jet Washer being used for routine examination of an asymptomatic patient? 
Effective Date

01/01/2066

Last Reviewed

NA

Original Document

  Reference



Background for this Policy

The Gravlee Jet Washer is a sterile, disposable, diagnostic device for detecting endometrial cancer.

The use of this device is indicated where the patient exhibits clinical symptoms or signs suggestive of endometrial disease, such as irregular or heavy vaginal bleeding.

Program payment cannot be made for the washer or the related diagnostic services when furnished in connection with the examination of an asymptomatic patient. Payment for routine physical checkups is precluded under the statute. (See §1862(a)(7) of the Act.)