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    OpenPayerBilling CodesEndometrial sampling, D&C and Uterus Tumor Excision ProceduresCPT cpt-58146-abdominal-myomectomy-5-plus-fibroids-gt-250g
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    CPT 58146: Abdominal Myomectomy, 5+ Fibroids, Total >250 g

    Medicare pays $1027 on average nationally for this procedure.

    CPT code 58146 describes an abdominal myomectomy in which the surgeon excises five or more uterine fibroid tumors with a total tumor weight greater than 250 g; the procedure is a major open gynecologic surgical service (myomectomy) performed via an abdominal approach and is typically provided in an inpatient hospital or ambulatory surgery center setting depending on clinical factors and facility capabilities.

    For related coverage guidance, see recent payer policy updates: Abortion Services, Prolonged Services for Labor Management, Prolonged Services for Labor Management.

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    Table of contents

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    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.

    Related CPT Codes

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

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207V00000X
    207L00000X
    163W00000X
    207XX0004X
    2086S0102X
    171400000X
    207NI0002X
    207QB0002X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    D25.0Submucous leiomyoma of uterus
    D25.1Intramural leiomyoma of uterus
    D25.2Subserosal leiomyoma of uterus
    D25.9Leiomyoma of uterus, unspecified
    D72.829Elevated white blood cell count, unspecified
    E03.9Hypothyroidism, unspecified
    E66.9Obesity, unspecified
    I10Essential (primary) hypertension
    I20.9Angina pectoris, unspecified
    K59.00Constipation, unspecified

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Obstetrics/Gynecology1 / 2

    10 rows

    PolicyPayerEffective Date
    Abortion ServicesNew Mexico Health Care Authority2027-01-01
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Obstetrical Home Care ProgramsAmbetter Georgia2026-11-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesPremera Bluecross2026-10-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesPremera Bluecross2026-10-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesBlue Cross Blue Shield - Massachusetts2026-10-01
    Cervical Cancer ScreeningOscar Health2026-10-01
    Prenatal Testing for Fetal AneuploidyOscar Health2026-10-01
    Diagnosis of VaginitisOscar Health2026-10-01

    Related Codes

    CPT-58100-ENDOMETRIAL-BIOPSY-OFFICE-AMBULATORY

    CPT 58100: Endometrial biopsy without cervical dilation

    CPT-58110-ENDOMETRIAL-BIOPSY-WITH-COLPOSCOPY

    CPT 58110: Endometrial Biopsy During Colposcopy

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

    CPT 58120: Dilation and Curettage for Uterine Bleeding

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

    CPT 58140: Myomectomy, Abdominal, 1–4 Fibroids ≤250 g

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

    CPT 58145: Vaginal Myomectomy, 1–4 Fibroids ≤250 g

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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