Audience: Radiologists and OB/GYNs
Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available for review and comment. Providers now have the capability of attaching supporting documentation related to their comments.
The following updated medical policy has been reviewed and was approved on November 18, 2021 by the Corporate Medical Policy Committee including practitioner representatives from all Health Plan regions.
The corporate medical policy listed below was updated to be consistent with eviCore Healthcare recommendations and is effective March 15, 2022. The policy applies to the services of all practitioners and facilities. The policy does not apply to all lines business. Benefits are contract dependent. Please refer to the medical policy and the member’s subscriber contract.
4.01.10 – Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome:
- The treatment is considered experimental/investigational
The rationale section of the medical policy provides information related to the Health Plan’s coverage criteria. These services are subject to audit and policy updates at the Health Plan’s discretion. Access the individual policies.
If you have questions regarding this policy, please contact your Provider Relations representative.
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