Coverage for Transcervical Fibroid Ablation

Effective for dates of service on or after July 1, 2025, the South Carolina Department of Health and Human Services (SCDHHS) will add coverage for transcervical fibroid ablation (TFA) as described below. TFA is a minimally invasive procedure that uses ultrasound-guided radiofrequency energy to target symptomatic uterine fibroids.

Treatment for symptomatic uterine fibroids via TFA will be covered without prior authorization for full-benefit Healthy Connections Medicaid members who meet the criteria below.

• Evidence of uterine fibroids between 3-10 centimeters is provided via ultrasound or other imaging; and
• Patient has at least one of the following symptoms that is a direct result of the fibroid(s):
  • Menorrhagia or other abnormal uterine bleeding that interferes with daily activities or causes anemia;
  • Pelvic pain or pressure;
  • Lower back pain that affects activities of daily living;
  • Urinary symptoms related to bulk compression of the bladder;
  • Gastrointestinal symptoms related to bulk compression of the bowel (e.g., constipation, bloating); or
  • Dyspareunia

These changes will be published in the Physicians Services Provider Manual on SCDHHS’ website by July 1, 2025. The reimbursement rate will be updated in the respective physician fee schedules available on SCDHHS’ website by July 1, 2025.

South Carolina’s Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for members enrolled in an MCO.  

Providers should direct questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at https://www.scdhhs.gov/providers/contact-provider-representative.

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