CPT 58145 Vaginal Myomectomy Reimbursement

CPT code 58145 represents a vaginal myomectomy for excision of 1 to 4 intramural uterine fibroids weighing 250 grams or less. Nationally, this procedure is a specific surgical option for patients with symptomatic fibroids when a vaginal route is appropriate, and it influences hospital and ambulatory surgery utilization, coding specificity, and payment determinations. Coverage and payment practices for this code affect surgical site selection, resource use, and billing accuracy across payers.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, expected sites of service, and benchmarking of how payers commonly address surgical myomectomy coding and coverage. The publication also summarizes common modifiers used with the code, discusses typical payer policy themes relevant to fibroid surgery, and highlights points of attention for accurate claim submission. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 58145 describes a surgical procedure in which the physician excises 1 to 4 uterine fibroid tumors (leiomyomas) weighing 250 grams or less that are located within the uterine corpus, using a vaginal approach. This procedure is a form of myomectomy performed through the vagina.

Service type: Surgical excision of uterine fibroids via vaginal approach
Typical site of service: Ambulatory surgical center or inpatient hospital operating room, performed by an obstetrics and gynecology surgeon

Clinical Context

A 38-year-old woman presents with symptomatic uterine fibroids causing heavy menstrual bleeding and pelvic pressure. Conservative management with hormonal therapy and iron supplementation failed to control symptoms. Preoperative evaluation includes pelvic imaging (transvaginal ultrasound or MRI) confirming 1–4 intramural/submucosal fibroids within the uterine corpus with combined specimen weight estimated ≤250 g, laboratory testing (CBC, type and screen), and anesthesia assessment. The patient is scheduled for a vaginal myomectomy with regional or general anesthesia. In the operating room, the gynecologic surgeon places the patient in lithotomy position, achieves adequate exposure, and performs an incision through the vaginal cuff and uterine corpus as needed to excise 1–4 fibroid tumors located within the body of the uterus. Hemostasis is achieved, uterine defects are repaired, and specimens are submitted for pathologic analysis. Typical postoperative workflow includes PACU recovery, pain control, monitoring for bleeding or infection, discharge with activity restrictions and follow-up for pathology review and wound check. The procedure is typically performed in an outpatient surgery center or hospital operating room with gynecology/urogynecology staffing and perioperative nursing support.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical expectations for a vaginal myomectomy.

Taxonomy Code	Specialty	Notes
`208500000X`	Obstetrics & Gynecology	Gynecologic surgeons commonly perform vaginal myomectomy.
`2086S0122X`	Female Pelvic Medicine & Reconstructive Surgery	Urogynecologists may perform complex vaginal uterine procedures.
`207V00000X`	Gynecologic Oncology	Gynecologic oncologists may be involved if malignancy is suspected.
`363A00000X`	Anesthesiology	Provides general or regional anesthesia for the procedure.
`1744P0800X`	Surgical Hospitalist	Perioperative surgeons involved in hospital-based operative care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D25.0`	Submucous leiomyoma of uterus	Common indication when fibroids distort the uterine cavity and cause heavy bleeding; may be amenable to vaginal myomectomy.
`D25.1`	Intramural leiomyoma of uterus	Frequent indication when fibroids are located within the uterine wall and symptomatic.
`D25.2`	Subserous leiomyoma of uterus	May be included when subserosal fibroids are accessible for removal through vaginal approach in select cases.
`N93.9`	Abnormal uterine and vaginal bleeding, unspecified	Symptom-driven diagnosis associated with fibroid-related bleeding prompting myomectomy.
`N80.0`	Endometriosis of uterus (adenomyosis)	May coexist with fibroids and contribute to pain/bleeding; relevant to surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`58150`	Total abdominal hysterectomy, for uterus 250 g or less	Alternative definitive procedure if fibroid burden or surgical approach requires hysterectomy instead of myomectomy.
`57540`	Vaginal hysterectomy, for uterus 250 g or less, with or without removal of tube(s), and/or ovary(ies)	Performed when hysterectomy is indicated via vaginal route rather than myomectomy.
`58260`	Total abdominal hysterectomy with salpingo-oophorectomy	Performed if adnexal removal is required in addition to uterine surgery.
`58340`	Tubal ligation, postpartum or interval	May be performed concurrently if patient requests permanent sterilization and clinical circumstances permit.
`76942`	Ultrasonic guidance for intraoperative procedures	May be used intraoperatively for localization of deep intramural fibroids if available.

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Summary & Overview

CPT 58145: Vaginal Myomectomy for Excision of 1–4 Uterine Fibroids