Does Health Insurance Pay For Tubal Reversal Surgery?

Insurance And Tubal Reversal

Kelly Rogers, RN, BSN - Tubal Reversal Nurse
Kelly Rogers, RN, BSN
Tubal Reversal Nurse

A common question we receive from potential patients is, “Will my insurance pay for tubal reversal?

Although some insurance companies may cover part of the cost of tubal ligation reversal, most insurance companies consider the surgery an elective procedure and will not pay for reversal surgery.

How can you determine if your insurance will pay for your surgery?

Health insurance is a contract between you, the patient, and the health insurance company.

The best way to determine if your health insurance company will pay for your reversal surgery is to call your health insurance company and ask if they will cover your procedure.

They will often ask you for both the ICD-9 diagnosis code and the CPT surgical procedure code before they can determine if the procedure is covered. Below are the ICD-9 and CPT codes for our tubal surgery procedures.

Tubal ligation reversal
This series of codes are for patients who want reversal of their tubal ligations.
ICD-9 code for bilateral tubal occlusion is 628.2
CPT code for tubal reversal is 58750

Screening laparoscopy
This series of codes are only for patients who will be having a screening laparoscopy procedure during their tubal reversal surgery. They will need both these codes and the tubal reversal codes shown above.
ICD-9 code for bilateral tubal occlusion is 628.2
CPT code for screening laparoscopy 49320

Essure reversal
This series of codes are for patients who want Essure reversed and want to become pregnant.
ICD-9 code for bilateral tubal occlusion 628.2
CPT code for Essure coil removal 49000
CPT code for tubo-uterine implantation 58752

Essure coil removal only
This series of codes are for patients who want Essure removed and do not want to become pregnant.
ICD-9 code for bilateral tubal occlusion 628.2
CPT code for Essure coil removal 49000
CPT code for tubal occlusion 58600

Essure coil removal and tubal reversal
This series of codes are for patients who want Essure removed but also want their tubes rejoined.
ICD-9 code for bilateral tubal occlusion 628.2
CPT code for Essure coil removal 49000
CPT code for tubotubal anastomosis 58750

Health Insurance and tubal reversal: Advice on obtaining reimbursement

Any pre-certification or pre-authorization required by insurance policies is the responsibility of the patient. Since our surgical fees are all-inclusive, we do not provide a cost breakdown to insurance companies. We are a fee for service practice and do not accept payments from insurance carriers or file insurance claims.

If your insurance carrier will cover part or all of the cost of your surgery, please be sure they send the reimbursement check to you directly. They will only send your reimbursement after surgery has been completed.

After your surgery, we can provide you with receipts and information documenting your procedure with the supporting ICD-9 and CPT codes. You can then submit this information to your insurance company and you can coordinate any possible reimbursement with your health insurance provider.

If you are fortunate enough to have insurance that will cover tubal surgery you will have to pay out of pocket for your surgery and be reimbursed directly by your health insurance company after surgery is performed and the completed paperwork has been submitted.