Prior Authorization
Humana Prior Authorization for CPT 58571
Abdominal and laparoscopic hysterectomy · Standard commercial plans
Source
Humana Commercial Preauthorization and Notification List (July 2024)Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Humana requires prior authorization for laparoscopic hysterectomy. Approved for symptomatic fibroids after failed medical management, AUB unresponsive to hormonal therapy, endometriosis with failed conservative treatment, and malignancy. Less invasive options should be documented as considered or contraindicated.
Documentation checklist
- ✓Clinical notes with diagnosis
- ✓Pelvic ultrasound or MRI
- ✓Medical management records
- ✓Endometrial biopsy if abnormal bleeding
Submission channels
Phone
1-800-444-9137Fax
1-877-418-05062026 Medicare rate for CPT 58571
Office (non-facility)
$828.68
Facility
$828.68
Total RVUs (office)
24.81
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 58571 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical notes with diagnosis, Pelvic ultrasound or MRI, Medical management records….
- 3Submit via phone or fax, or the payer portal.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Humana require prior authorization for CPT 58571?
- Yes. Humana requires prior authorization for CPT 58571 (Abdominal and laparoscopic hysterectomy) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT 58571?
- Clinical notes with diagnosis; Pelvic ultrasound or MRI; Medical management records; Endometrial biopsy if abnormal bleeding
- How much does Medicare pay for CPT 58571 in 2026?
- In 2026, the national Medicare allowable for CPT 58571 is $828.68 in an office setting and $828.68 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
- What if Humana denies the PA for CPT 58571?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Humana PA lookups
CPT 58571 prior authorization by payer
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