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Medical Policy Original Effective Date: 051710 Revised Date: 012517-Page 1 of 2Hysterectomy MPM 8.9DisclaimerRefer to the members specific benefit plan and Schedule of Benefits to determine coverage.

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Revised date 01-25-17 refers to the updated version or version reviewed on January 25, 2017.

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What is the purpose of revised date 01-25-17?

The purpose of revised date 01-25-17 is to ensure that the information is current and up to date as of January 25, 2017.

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Any information or data that was reviewed, updated, or changed on January 25, 2017, must be reported.

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