The following CPT Fourth Edition codes may be used to report procedures associated with Essure:
|Essure procedure||58565||Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants|
|Modified HSG||58340||Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or HSG|
|Modified HSG, interpretation and supervision||74740||HSG, radiologic supervision and interpretation|
|Modified HSG, interpretation||74740-26||HSG, radiologic supervision and interpretation, professional component only|
|Modified HSG, supervision||74740-TC||HSG, radiologic supervision and interpretation, technical component only|
The following HCPCS code may
be used (in addition to the CPT
code) for selected payers that, including some state Medicaid† programs, allow for separate payment. Please check with the payer to confirm whether
payment is separate or bundled.
|Essure procedure||A4264||Permanent implantable contraceptive intratubal occlusion device(s) and delivery system|
For many payers, the following codes from the International Classification of Diseases, 10th edition, may be used to identify the Essure Confirmation Test with modified HSG/TVU as a preventive service:
|Essure procedure||Z30.2||Encounter for sterilization|
|Essure Confirmation Test||Z98.51||Tubal ligation status|
|Essure Confirmation Test (identified as a preventive service)||Z30.8||Other specified contraceptive management|
|Essure Confirmation Test||Z30.49||Surveillance of other contraceptive management|
CPT Modifier 33 is applicable for the identification of preventive services without cost sharing‡ and may be added to the following CPT codes:
|Essure procedure||58565-33||Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants|
|Modified HSG||58340-33||Catheterization and introduction of saline or contrast material for SIS or HSG|
For all codes and more information about reimbursement, download the guide below.Essure Reimbursement
The ACA has helped make health insurance and healthcare services more affordable and accessible for millions of people who previously did not have coverage.1 The ACA generally requires health plans to cover FDA-approved contraceptive methods as a preventative service at low or no cost to the patient (eg, copayment, coinsurance). However, depending on the specific insurance plan, the patient may still be responsible for the cost of the product and/or product-related costs, such as insertion or removal procedure fees.1
Multiple necessary services are performed by a healthcare provider during a procedure. These services are said to be billed/paid “globally”—sometimes referred to as the global/surgical package. The global/surgical package also includes a global period: a set number of days during the postoperative period. The global period is usually 90 days for major procedures and 0 to 10 days for minor procedures. Therefore, all follow‑up care, including the treatment of complications, is included in the global period and cannot be billed separately.
Because the Essure Instructions for Use states than an Essure Confirmation Test with TVU/modified HSG is a required part of the Essure procedure, it is considered typical and usual, and will not be paid separately if it is performed within the 90-day global period of the Essure procedure.
Although this information should help make filing claims easier and help reduce claim rejection, its use does not guarantee payment. It is important to research coverage and payment for each patient since policies and guidelines vary by payer and plan. You are responsible for submitting accurate, complete, and appropriate claims to payers, and for compliance with any obligations you may have as required by law, contract, or otherwise.
For more information, call our reimbursement hotline at 1-877-ESSURE21-877-ESSURE2 and press “#”.
Reference: 1. HRSA. Women's Preventative Services Guidelines. https://www.hrsa.gov/womens-guidelines/index.html. Accessed October 17, 2017.
Starting on August 1st, 2018, a EPDA Form must be signed by active Essure user(s), within an account stating they will use the Checklist with all patients prior to the procedure.
Starting on August 1st, 2018, the user facility will need to submit an EFCF to confirm that the purchased product will only be distributed to a physician within the account that has a signed EPDA on fileGo to Form
Essure® is indicated for women who desire permanent birth control (female sterilization) by bilateral occlusion of the fallopian tubes.
WARNING: Some patients implanted with the Essure System for Permanent Birth Control have experienced and/or reported adverse events, including perforation of the uterus and/or fallopian tubes, identification of inserts in the abdominal or pelvic cavity, persistent pain, and suspected allergic or hypersensitivity reactions. If the device needs to be removed to address such an adverse event, a surgical procedure will be required. This information should be shared with patients considering sterilization with the Essure System for Permanent Birth Control during discussion of the benefits and risks of the device.
Essure is contraindicated in patients who are uncertain about ending fertility, can have only one insert placed (including contralateral proximal tubal occlusion or suspected unicornuate uterus), have a known abnormal uterine cavity that makes visualization of the tubal ostia impossible, and/or abnormal tubal anatomy or previous tubal ligation (including failed ligation), are pregnant or suspect pregnancy, delivered or terminated a pregnancy less than 6 weeks prior to the Essure procedure, have an active upper or lower genital tract infection, have unexplained vaginal bleeding, have a gynecological malignancy, or have a known allergy to contrast media.
The Essure insert was determined to be MR-conditional according to the terminology specified in the American Society for Testing and Materials (ASTM) International, Designation: F2503-05.
The most common (≥10%) adverse events resulting from the placement procedure were cramping, pain, and nausea/vomiting. The most common adverse events (≥3%) in the first year of reliance were back pain, abdominal pain, and dyspareunia.
This product does not protect against HIV infection or other sexually transmitted diseases.
You are also encouraged to report side effects or quality complaints of products to the FDA by visiting www.fda.gov/medwatch or calling 1-800-FDA-10881-800-FDA-1088. For Bayer products, you can report these directly to Bayer by clicking here.