CPT 58146 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 58146: Abdominal Myomectomy for 5+ Uterine Fibroids, >250 g

CPT code 58146 represents an open abdominal myomectomy for removal of five or more uterine fibroids with a combined tumor weight exceeding 250 grams. This code captures a higher-complexity gynecologic procedure that typically involves greater operative time, increased resource use, and potential inpatient care compared with less extensive myomectomies. Nationally, accurate coding for extensive myomectomy is important for clinical reporting, care coordination, and payer adjudication given differences in coverage policies and site-of-service determinations. Major payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical context of 58146, the expected site-of-service and service type, common billing modifiers and related administrative considerations, and where this code fits among related myomectomy codes. The publication summarizes payer coverage patterns and authorization nuances at a national level, highlights documentation elements relevant to case complexity, and outlines benchmarks and coding relationships to aid revenue cycle and clinical teams. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 58146gynecologymyomectomyuterine fibroidssurgical-proceduresinpatient-surgeryambulatory-surgeryprocedure-coding

Billing Code Overview

CPT code 58146 describes an open abdominal myomectomy in which the physician excises five or more uterine fibroid tumors with a total tumor weight greater than 250 grams. The procedure is a surgical removal of leiomyomas from the uterus using an abdominal (laparotomy) approach.

Service type: Major gynecologic surgical procedure (open abdominal myomectomy)

Typical site of service: Inpatient hospital or ambulatory surgical center depending on clinical status and payer policies.

Clinical & Coding Specifications

Clinical Context

A 38-year-old woman with symptomatic uterine fibroids presents with heavy menstrual bleeding, pelvic pain, and anemia refractory to medical therapy. Imaging (pelvic ultrasound and MRI) demonstrates multiple intramural and subserosal leiomyomas with at least five discrete tumors whose combined estimated mass and imaging measurements are consistent with a total tumor weight >250 g. After counseling, the patient is scheduled for an open abdominal myomectomy. Preoperative workflow includes pre-op labs (CBC, type and screen), anesthesia evaluation, informed consent addressing fertility preservation and blood-loss risk, and arrangement for possible intraoperative blood transfusion. The procedure is performed in a hospital operating room with general anesthesia by a gynecologic surgeon experienced in open uterine surgery. Intraoperative steps include laparotomy, identification and enucleation of five or more leiomyomas, meticulous hemostasis, possible use of uterine-sparing techniques, and layered uterine and abdominal closure. Postoperative care occurs in the post-anesthesia care unit and inpatient ward with monitoring for hemorrhage, infection, and pain control. Documentation must support the abdominal approach, number of fibroids removed (≥5), and total tumor weight (>250 g) to substantiate use of 58146.

Coding Specifications

Modifier	Description	When to Use
`00`	Procedure performed with no anatomical or procedural qualifier (default)

CPT 58110: Endometrial Biopsy Performed with Colposcopy

CPT-58140-ABDOMINAL-MYOMECTOMY-1-TO-4-FIBROIDS-250G-OR-LESS

CPT 58140: Abdominal Myomectomy for 1–4 Uterine Fibroids

CPT-58145-VAGINAL-MYOMECTOMY-UTERINE-FIBROID-EXCISION-1-TO-4-TUMORS

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

CPT-58100-ENDOMETRIAL-BIOPSY-OFFICE-AMBULATORY

CPT 58100: Endometrial Biopsy Without Cervical Dilation

CPT-58120-ENDOMETRIAL-CURETTAGE-DILATION-AND-CURETTAGE

CPT 58120: Dilation and Curettage of Uterine Lining

Taxonomy Code	Specialty	Notes
`193100000X`	Obstetrics & Gynecology	Gynecologic surgeons who perform abdominal myomectomy.
`207V00000X`	Surgery	General surgeons with gynecologic experience in complex abdominal procedures (occasionally involved).
`207L00000X`	Obstetrics & Gynecology - Gynecology	Subspecialty-focused gynecologists who manage uterine-sparing surgery.
`364000000X`	Anesthesiology	Anesthesia providers for general or regional anesthesia during open myomectomy.
`163W00000X`	Certified Registered Nurse Anesthetist (CRNA)	Common anesthesia clinicians in the operative setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D25.9`	Leiomyoma of uterus, unspecified	General code for uterine fibroids; primary indication for myomectomy.
`D25.0`	Leiomyoma of uterus, submucous	Submucosal fibroids causing bleeding and infertility; may be part of multiple-fibroid burden requiring open removal if numerous.
`D25.1`	Leiomyoma of uterus, intramural	Intramural fibroids that enlarge the uterine wall and cause pain, bleeding, or bulk symptoms prompting myomectomy.
`D25.2`	Leiomyoma of uterus, subserosal	Subserosal fibroids producing pelvic pressure and pain; may require open excision when numerous or large.
`N92.0`	Excessive and frequent menstruation with regular cycle	Clinical symptom often secondary to fibroids and an indication for surgical management when refractory to medical therapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`58150`	Excision of submucous leiomyoma, with repair of uterine wall and/or metritis (1 or more) performed hysteroscopically or via hysteroscopy	Alternative approach for submucosal fibroids when hysteroscopic technique is appropriate; may be used for select fibroids instead of open myomectomy.
`58558`	Hysteroscopy, surgical; with removal of leiomyomata (myomectomy), hysteroscopic	Minimally invasive alternative when fibroids are intracavitary/submucosal and suitable for hysteroscopic removal.
`58120`	Myomectomy, excision of fibroid tumor(s) of uterus, one or more, total weight 250 g or less, abdominal approach	Used when total tumor weight is ≤250 g; distinguishes from `58146` by tumor weight and/or number criteria.
`49505`	Repair initial inguinal hernia, age 5 years or older; reducible	Data not available in the input.
`51702`	Bladder catheterization, simple (separate procedure)	Common adjunct procedure for urinary drainage during and after abdominal myomectomy.
`99100`	Anesthesia for procedures on the lower abdomen, perineum and pelvis; complicated	Anesthesia add-on codes may be used when anesthesia services meet complexity criteria during open abdominal myomectomy.

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