Summary & Overview
CPT 58563: Hysteroscopic Surgical Endometrial Ablation
CPT code 58563 is a nationally recognized billing code for hysteroscopic surgical procedures involving endometrial ablation. This minimally invasive gynecologic intervention is commonly used to address abnormal uterine bleeding and related conditions, providing an alternative to more invasive surgical options. The code is relevant for both office-based and hospital outpatient settings, with device costs typically bundled in the latter.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, reflecting broad national coverage and reimbursement interest. Readers will gain insight into payer coverage, clinical indications, and the procedural context for 58563. The publication also highlights related codes, common modifiers, and associated taxonomies, offering a comprehensive overview for stakeholders in medical billing, policy, and clinical operations.
Key benchmarks and policy updates are discussed, along with the clinical context for endometrial ablation procedures. This summary provides a clear understanding of the code's significance in surgical gynecology, its typical sites of service, and its role in treating excessive or frequent menstruation. The information is designed to support informed decision-making for healthcare administrators, policy analysts, and clinical teams.
CPT Code Overview
CPT code 58563 describes a hysteroscopic surgical procedure with endometrial ablation, which may include endometrial resection, electrosurgical ablation, or thermoablation. This code is used in surgical gynecology to treat conditions such as abnormal uterine bleeding. The procedure is typically performed in an office setting (Place of Service 11) or in a hospital outpatient facility, where device costs are often bundled. The use of hysteroscopy allows for direct visualization and targeted treatment of the endometrial lining, offering a minimally invasive option for patients requiring endometrial ablation.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a woman presenting with abnormal uterine bleeding, such as excessive or frequent menstruation with irregular cycles or postmenopausal bleeding. After evaluation by a gynecology or obstetrics & gynecology physician, the patient is scheduled for a hysteroscopic endometrial ablation procedure (CPT 58563) to treat the underlying cause of the bleeding. The procedure is performed in an office or hospital outpatient setting, where the physician uses hysteroscopic guidance to ablate the endometrial lining, aiming to reduce or eliminate abnormal bleeding. The clinical workflow includes pre-procedure assessment, anesthesia administration (often via paracervical block), hysteroscopic visualization, endometrial ablation, and post-procedure monitoring.
Coding Specifications
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Modifier
51(Multiple Procedures): Used when more than one procedure is performed during the same session, indicating thatCPT 58563is one of several procedures. -
Modifier
59(Distinct Procedural Service): Applied whenCPT 58563is performed as a distinct service from other procedures, such as when performed separately from other gynecologic interventions.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207VG0400X | Gynecology Physician |
207V00000X | Obstetrics & Gynecology Physician |
207VX0000X | Obstetrics Physician |
Related Diagnoses
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N92.0- Excessive or frequent menstruation with irregular cycle- This diagnosis is clinically relevant as it describes patients experiencing abnormal uterine bleeding, which is a primary indication for endometrial ablation via hysteroscopy.
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N92.4- Excessive or frequent menstruation in postmenopausal period- This diagnosis applies to postmenopausal women with abnormal bleeding, another key indication for performing hysteroscopic endometrial ablation (
CPT 58563).
- This diagnosis applies to postmenopausal women with abnormal bleeding, another key indication for performing hysteroscopic endometrial ablation (
Related CPT Codes
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58353- Endometrial ablation, thermal, without hysteroscopic guidance- This code represents endometrial ablation performed without the use of hysteroscopy. It is an alternative to
CPT 58563when hysteroscopic visualization is not used.
- This code represents endometrial ablation performed without the use of hysteroscopy. It is an alternative to
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58565- Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants- This code is used for hysteroscopic procedures involving fallopian tube occlusion. It may be performed in conjunction with or as an alternative to endometrial ablation, depending on patient needs.
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64435- Injection, anesthetic agent; paracervical (uterine) nerve- This code is commonly used together with
CPT 58563to provide local anesthesia during the procedure, facilitating patient comfort.
- This code is commonly used together with
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 58563 is $2,098.94, which is higher than the BUCA (average commercial) mean rate of $1,500.35. Among commercial payers, UnitedHealth Group has the highest mean rate at $2,365.38, while Aetna is the lowest at $966.35.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Aetna shows the tightest range ($478.12), indicating less variability in rates, while Cigna and UnitedHealth Group exhibit the widest dispersions ($1,163.00 and $1,192.89, respectively), reflecting greater variability in contracted rates. The table and chart below present the full breakdown of national benchmarks for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.