CPT Code 58573 Laparoscopy, Surgical; Total Hysterectomy for Uterus >250g with Removal of Tube(s) and/or Ovary(s)

Accurate coding for complex gynecologic surgeries is essential for appropriate reimbursement and compliance. CPT 58573 represents a laparoscopic total hysterectomy with removal of tubes and/or ovaries (salpingo-oophorectomy) for a uterus weighing greater than 250 grams.

This advanced minimally invasive surgery is performed for patients with large uteri, multiple fibroids, or coexisting adnexal pathology, combining hysterectomy with salpingo-oophorectomy when indicated. Correct coding ensures that providers are paid fairly for the additional surgical work and complexity involved.

CPT Code 58573 – Description of the Procedure

Official CPT Definition: “Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s).”

This procedure includes complete removal of the uterus and cervix via a laparoscopic approach, along with unilateral or bilateral removal of fallopian tubes and/or ovaries. The uterus being removed weighs more than 250 grams, which adds technical difficulty to the operation.

The surgery typically involves:

• Laparoscopic visualization of pelvic anatomy.
• Detachment of the uterus, adnexa, and supporting ligaments.
• Control of the uterine and ovarian blood supply.
• Specimen removal through the vagina or the morcellation technique.

Because of the increased uterine size and the addition of adnexal surgery, CPT 58573 represents a major gynecologic procedure with higher reimbursement than 58570 or 58571.

When to Use CPT 58573

Use CPT 58573 when performing a laparoscopic total hysterectomy with salpingo-oophorectomy (removal of one or both ovaries and/or fallopian tubes) and the uterus weighs more than 250 grams.

Common Clinical Indications:

• Large uterine fibroids causing bulk symptoms or bleeding
• Uterine enlargement with adnexal masses or cysts
• Endometriosis involving the uterus and ovaries
• Pelvic pain unresponsive to conservative therapy
• Postmenopausal bleeding with adnexal pathology
• Benign or premalignant adnexal lesions requiring removal

Do not report 58573 if:

• The uterus weighs 250 grams or less (use 58572).
• Only the uterus is removed (use 58571).
• The approach is abdominal or vaginal (use 58150 or 58260–58262).
• A radical hysterectomy for malignancy is performed - this requires a different code set.

Coding Guidelines and Billing Rules

Follow these coding and documentation principles for compliant billing:

• Single reporting: Report 58573 once per session for the entire laparoscopic procedure.
• Includes: Total hysterectomy, salpingectomy, and/or oophorectomy when performed.
• Separate reporting: If additional non-bundled laparoscopic procedures are performed (e.g., adhesiolysis beyond the typical scope), they may be billed separately with appropriate modifiers.
• Global period: 90 days.
• Setting: Typically performed in a hospital or ambulatory surgical center.
• Prior authorization: Required by most payers for non-emergent hysterectomies. Include failed medical therapy documentation.

Reimbursement and Coverage Information

Reimbursement for CPT 58573 reflects its surgical complexity and longer operative time compared to 58570–58572.

Approximate Medicare Payment Rates:

• Physician (facility): $1,300–$1,500
• Hospital Outpatient Facility: $2,400–$2,900
• ASC Payment: $2,000–$2,500
• Global Period: 90 days

Common ICD-10 Codes Supporting Medical Necessity:

• D25.2 – Subserosal leiomyoma of the uterus
• N80.9 – Endometriosis, unspecified
• N83.201 – Unspecified ovarian cyst, right side
• N93.9 – Abnormal uterine and vaginal bleeding, unspecified
• N85.9 – Noninflammatory disorder of uterus, unspecified

Always verify payer-specific guidelines, as coverage criteria may vary by insurance plan and medical necessity documentation.

Modifier Use

Modifiers clarify the surgical scope and prevent claim denials.

• Modifier 51 – Multiple procedures during the same session (e.g., extensive adhesiolysis).
• Modifier 52 – Reduced services (procedure partially completed).
• Modifier 59 – Distinct procedural service when justified.
• Modifiers 54, 55, 56 – When care is split between providers.
• Modifier 22 – Increased procedural service (for extensive adhesions or challenging anatomy).

Always ensure modifier use is justified and supported in the operative note.

Documentation Requirements

Detailed documentation is essential for correct coding and audit defense. Include:

• Preoperative diagnosis and indication (fibroids, endometriosis, etc.)
• Uterine weight (must exceed 250 grams)
• Details of structures removed (uterus, tubes, ovaries)
• Approach and technique (laparoscopic entry, hemostasis, specimen retrieval)
• Intraoperative findings (adhesions, cysts, pathology)
• Complications or additional steps taken
• Confirmation of pathology submission

Complete documentation supports appropriate coding, modifier use, and reimbursement.

Example Scenarios

Scenario 1 – Laparoscopic Total Hysterectomy with Bilateral Salpingo-Oophorectomy

A 50-year-old woman with symptomatic fibroids and ovarian cysts undergoes a laparoscopic total hysterectomy with removal of both tubes and ovaries. The uterus weighs 310 grams.

→ Report CPT 58573.

Scenario 2 – Laparoscopic Hysterectomy with Unilateral Oophorectomy

A patient has endometriosis involving one ovary and an enlarged uterus (280 grams). Surgeon performs total laparoscopic hysterectomy with right oophorectomy only.

→ Report CPT 58573 (includes removal of one or both ovaries).

Scenario 3 – Laparoscopic Hysterectomy with Extensive Adhesiolysis

A 47-year-old with a 350-gram fibroid uterus and dense pelvic adhesions undergoes total laparoscopic hysterectomy with bilateral salpingectomy and extensive adhesiolysis.

→ Report CPT 58573 and consider modifier 22 for increased complexity (supported by operative note).

These examples demonstrate how documentation of uterine weight, adnexal removal, and operative detail determines accurate CPT and modifier selection.

Why Choose BillingFreedom for OBGYN Billing

Laparoscopic hysterectomy coding can be challenging, primarily when the weight of the uterus and adnexal procedures affects CPT selection. Missing such details can lead to underpayment or claim denials.

At BillingFreedom, our team of certified coders specializes in OBGYN medical billing services, ensuring accurate code assignment, clean claims, and compliant reimbursement. We help OBGYN practices stay aligned with CMS and AAPC guidelines while optimizing their revenue cycle.

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