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CPT 58240: Pelvic Exenteration for Recurrent or Advanced Cervical Cancer

CPT code 58240 denotes pelvic exenteration, a major multi-organ surgical procedure most commonly used for recurrent cervical cancer after radiation or for advanced tumors involving both bladder and rectum. This code captures highly complex oncologic resections that may include removal of the uterus, adnexa, bladder, rectum, vagina, urethra, and portions of pelvic floor musculature. Pelvic exenteration represents one of the most resource-intensive gynecologic oncology operations and has significant implications for hospital resource use, post-operative care, and long-term survivorship and quality-of-life planning.

Key payers relevant to national reimbursement and coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, an outline of typical sites of service and service type, and a guide to what the code represents for billing and administrative workflows. The publication also summarizes benchmarks, common modifier usage, and policy considerations that affect authorization, bundling, and inpatient payment practices. This material is written for national audiences involved in coding, billing, utilization management, and clinical program planning.

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Billing Code Overview

CPT code 58240 describes a pelvic exenteration procedure performed for patients with recurrent cervical cancer after prior radiation therapy or for selected patients with stage IV disease involving both the bladder and rectum. The procedure is extensive and variable: in a total exenteration, the surgeon removes the uterus, fallopian tubes, ovaries, parametrial tissue, bladder, rectum, vagina, urethra, and portions of the levator ani muscles; anterior and posterior exenterations spare the rectum or bladder/urethra, respectively. Resection may also include portions of the anus, urethra, and vulva depending on tumor location and extent.

Service type: Major pelvic oncologic surgery / multi-organ resection

Typical site of service: Inpatient hospital setting (operative theatre with post-operative inpatient care)

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CPT 58240: Pelvic Exenteration for Recurrent or Advanced Cervical Cancer

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Billing Code Overview

Service type: Major pelvic oncologic surgery / multi-organ resection

Typical site of service: Inpatient hospital setting (operative theatre with post-operative inpatient care)

Clinical & Coding Specifications

Clinical Context

A 58-year-old woman with a history of cervical squamous cell carcinoma previously treated with definitive pelvic radiotherapy presents with pelvic pain, recurrent vaginal bleeding, and fecal urgency. Imaging and cystoscopy confirm a locally recurrent tumor involving the central pelvis with extension into the urinary bladder and rectum. After multidisciplinary tumor board review and informed consent, the patient is scheduled for a total pelvic exenteration to achieve oncologic resection and palliation of symptoms. The perioperative workflow includes preoperative optimization (cardiopulmonary evaluation, nutritional assessment, stoma teaching), bowel and urinary diversion planning, intraoperative en bloc resection of involved organs (uterus, adnexa, bladder, rectum, vagina, distal urethra, portion of levator complex as indicated), creation of an end colostomy and urinary diversion (ileal conduit or continent diversion), intraoperative frozen sections as needed, and postoperative ICU or step-down monitoring with pain control, infection surveillance, stoma care, and coordination of adjuvant oncology follow-up.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work, time, and complexity of the exenteration substantially exceed typical expectations.
`23`	Unusual anesthesia (surgery performed under general anesthesia when normally local/monitored would be used)	Rarely used; apply only if anesthesia documentation supports unusual circumstances compared with typical for the service.
`26`	Professional component	Use if billing only for the physician professional component distinct from technical facilities (rare for operative CPTs).
`53`	Discontinued procedure	Use when the exenteration was started but terminated for patient safety reasons before completion.
`54`	Surgical care only	Use when another provider bills for pre- and post-operative care and the surgeon bills only for the operative portion.
`55`	Postoperative management only	Use when the surgeon bills only for postoperative care and did not perform the surgery.
`62`	Two surgeons	Use when two surgeons of different skills work together as primary surgeons during the exenteration.
`66`	Surgical team	Use when multiple surgeons function as a surgical team for complex exenterative procedures.
`80`	Assistant surgeon	Use when a surgical assistant (physician) assists the primary surgeon.
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon role is documented.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant is required.
`50`	Bilateral procedure	Not typically applicable; include only if a separate bilateral anatomic procedure is relevant and supported by documentation.
`62`	Two surgeons	(Duplicate entry avoided in practice; listed above as clinically relevant.)

Taxonomy Code	Specialty	Notes
208100000X	Gynecologic Oncology	Primary specialty performing pelvic exenteration for recurrent cervical or advanced pelvic malignancy.
2086S0122X	General Surgery - Surgical Oncology	General surgical oncologists who perform pelvic exenterations in multidisciplinary centers.
207V00000X	Obstetrics & Gynecology	Gynecologic surgeons in complex pelvic oncology cases; often part of the operative team.
363L00000X	Urology	Urologists commonly perform or collaborate on urinary diversion and bladder resection portions of exenteration.
207R00000X	Colorectal Surgery	Colorectal surgeons perform the rectal resection and stoma creation components of posterior pelvic exenteration.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C53.9`	Malignant neoplasm of cervix uteri, unspecified	Primary diagnosis for cervical cancer recurrence leading to consideration of pelvic exenteration.
`C53.1`	Malignant neoplasm of endocervix	Specific cervical tumor site that may recur after radiation and necessitate exenteration if locally invasive.
`C79.81`	Secondary malignant neoplasm of bone	Represents distant metastasis; generally a contraindication to curative exenteration but may impact surgical decision-making for palliation.
`C79.9`	Secondary malignant neoplasm of unspecified site	Documentation of metastatic disease that influences candidacy for exenteration.
`Z85.42`	Personal history of malignant neoplasm of cervix uteri	Relevant to history and surveillance; may be present in the chart of patients undergoing exenteration for recurrence.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Enterectomy, resection of small intestine with anastomosis	May be used when bowel resection and primary anastomosis are required during urinary or fecal diversion planning.
`44143`	Colectomy, partial; with colostomy	Applied if a portion of colon is resected and an end colostomy is constructed as part of exenteration.
`50820`	Cystectomy, simple; removal of bladder and creation of urinary diversion (ileal conduit)	Used when cystectomy with urinary diversion (ileal conduit) is performed as part of total or anterior exenteration.
`44625`	Resection of rectum with colorectal anastomosis	Used for low rectal resection with primary anastomosis when the rectum is partially resected during posterior or total exenteration.
`49560`	Construction of abdominal wall stoma (colostomy or ileostomy)	Used for creation of end colostomy or ileostomy as part of diversion after exenteration.
`49999`	Unlisted procedure, abdomen, peritoneum, and omentum	May be used for unique or additional open intra-abdominal procedures not separately described when performed during exenteration.

CPT 58150: Abdominal Hysterectomy with Cervix Removal

CPT-58152-ABDOMINAL-HYSTERECTOMY-URETHRAL-SUSPENSION

CPT 58152: Abdominal Hysterectomy with Urethral Suspension

CPT-58180-ABDOMINAL-HYSTERECTOMY-OPEN-UTERUS-REMOVAL

CPT 58180: Abdominal Hysterectomy, Open Removal of Uterus

CPT-58200-ABDOMINAL-HYSTERECTOMY-WITH-LYMPHADENECTOMY

CPT 58200: Abdominal Hysterectomy with Lymphadenectomy

CPT-58210-RADICAL-ABDOMINAL-HYSTERECTOMY-PELVIC-LYMPHADENECTOMY

CPT 58210: Radical Abdominal Hysterectomy with Pelvic Lymphadenectomy

CPT-58260-VAGINAL-HYSTERECTOMY-UTERUS-AND-CERVIX

CPT 58260: Vaginal Hysterectomy, Uterus and Cervix Only

CPT-58262-VAGINAL-HYSTERECTOMY-TOTAL-WITH-BSO-NORMAL-SIZE-UTERUS

CPT 58262: Vaginal Hysterectomy with Bilateral Salpingo-Oophorectomy

CPT-58263-VAGINAL-HYSTERECTOMY-BILATERAL-SALPINGO-OOPHORECTOMY-ENTEROCELE-REPAIR

CPT 58263: Vaginal Hysterectomy with Bilateral Salpingo-Oophorectomy and Enterocele Repair

CPT-58267-VAGINAL-HYSTERECTOMY-WITH-URETHRAL-SUSPENSION

CPT 58267: Vaginal Hysterectomy with Urethral Suspension

CPT-58270-VAGINAL-HYSTERECTOMY-SMALL-BOWEL-PROLAPSE-REPAIR

CPT 58270: Vaginal Hysterectomy with Small Bowel Prolapse Repair

Showing 1–10 of 17

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work, time, and complexity of the exenteration substantially exceed typical expectations.
`23`	Unusual anesthesia (surgery performed under general anesthesia when normally local/monitored would be used)	Rarely used; apply only if anesthesia documentation supports unusual circumstances compared with typical for the service.
`26`	Professional component	Use if billing only for the physician professional component distinct from technical facilities (rare for operative CPTs).
`53`	Discontinued procedure	Use when the exenteration was started but terminated for patient safety reasons before completion.
`54`	Surgical care only	Use when another provider bills for pre- and post-operative care and the surgeon bills only for the operative portion.
`55`	Postoperative management only	Use when the surgeon bills only for postoperative care and did not perform the surgery.
`62`	Two surgeons	Use when two surgeons of different skills work together as primary surgeons during the exenteration.
`66`	Surgical team	Use when multiple surgeons function as a surgical team for complex exenterative procedures.
`80`	Assistant surgeon	Use when a surgical assistant (physician) assists the primary surgeon.
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon role is documented.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant is required.
`50`	Bilateral procedure	Not typically applicable; include only if a separate bilateral anatomic procedure is relevant and supported by documentation.
`62`	Two surgeons	(Duplicate entry avoided in practice; listed above as clinically relevant.)

Taxonomy Code	Specialty	Notes
208100000X	Gynecologic Oncology	Primary specialty performing pelvic exenteration for recurrent cervical or advanced pelvic malignancy.
2086S0122X	General Surgery - Surgical Oncology	General surgical oncologists who perform pelvic exenterations in multidisciplinary centers.
207V00000X	Obstetrics & Gynecology	Gynecologic surgeons in complex pelvic oncology cases; often part of the operative team.
363L00000X	Urology	Urologists commonly perform or collaborate on urinary diversion and bladder resection portions of exenteration.
207R00000X	Colorectal Surgery	Colorectal surgeons perform the rectal resection and stoma creation components of posterior pelvic exenteration.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C53.9`	Malignant neoplasm of cervix uteri, unspecified	Primary diagnosis for cervical cancer recurrence leading to consideration of pelvic exenteration.
`C53.1`	Malignant neoplasm of endocervix	Specific cervical tumor site that may recur after radiation and necessitate exenteration if locally invasive.
`C79.81`	Secondary malignant neoplasm of bone	Represents distant metastasis; generally a contraindication to curative exenteration but may impact surgical decision-making for palliation.
`C79.9`	Secondary malignant neoplasm of unspecified site	Documentation of metastatic disease that influences candidacy for exenteration.
`Z85.42`	Personal history of malignant neoplasm of cervix uteri	Relevant to history and surveillance; may be present in the chart of patients undergoing exenteration for recurrence.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Enterectomy, resection of small intestine with anastomosis	May be used when bowel resection and primary anastomosis are required during urinary or fecal diversion planning.
`44143`	Colectomy, partial; with colostomy	Applied if a portion of colon is resected and an end colostomy is constructed as part of exenteration.
`50820`	Cystectomy, simple; removal of bladder and creation of urinary diversion (ileal conduit)	Used when cystectomy with urinary diversion (ileal conduit) is performed as part of total or anterior exenteration.
`44625`	Resection of rectum with colorectal anastomosis	Used for low rectal resection with primary anastomosis when the rectum is partially resected during posterior or total exenteration.
`49560`	Construction of abdominal wall stoma (colostomy or ileostomy)	Used for creation of end colostomy or ileostomy as part of diversion after exenteration.
`49999`	Unlisted procedure, abdomen, peritoneum, and omentum	May be used for unique or additional open intra-abdominal procedures not separately described when performed during exenteration.

CPT 58150: Abdominal Hysterectomy with Cervix Removal

CPT-58152-ABDOMINAL-HYSTERECTOMY-URETHRAL-SUSPENSION

CPT 58152: Abdominal Hysterectomy with Urethral Suspension

CPT-58180-ABDOMINAL-HYSTERECTOMY-OPEN-UTERUS-REMOVAL

CPT 58180: Abdominal Hysterectomy, Open Removal of Uterus

CPT-58200-ABDOMINAL-HYSTERECTOMY-WITH-LYMPHADENECTOMY

CPT 58200: Abdominal Hysterectomy with Lymphadenectomy

CPT-58210-RADICAL-ABDOMINAL-HYSTERECTOMY-PELVIC-LYMPHADENECTOMY

CPT 58210: Radical Abdominal Hysterectomy with Pelvic Lymphadenectomy

CPT-58260-VAGINAL-HYSTERECTOMY-UTERUS-AND-CERVIX

CPT 58260: Vaginal Hysterectomy, Uterus and Cervix Only

CPT-58262-VAGINAL-HYSTERECTOMY-TOTAL-WITH-BSO-NORMAL-SIZE-UTERUS

CPT 58262: Vaginal Hysterectomy with Bilateral Salpingo-Oophorectomy

CPT-58263-VAGINAL-HYSTERECTOMY-BILATERAL-SALPINGO-OOPHORECTOMY-ENTEROCELE-REPAIR

CPT 58263: Vaginal Hysterectomy with Bilateral Salpingo-Oophorectomy and Enterocele Repair

CPT-58267-VAGINAL-HYSTERECTOMY-WITH-URETHRAL-SUSPENSION

CPT 58267: Vaginal Hysterectomy with Urethral Suspension

CPT-58270-VAGINAL-HYSTERECTOMY-SMALL-BOWEL-PROLAPSE-REPAIR

CPT 58270: Vaginal Hysterectomy with Small Bowel Prolapse Repair

Showing 1–10 of 17

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 58240: Pelvic Exenteration for Recurrent or Advanced Cervical Cancer

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Billing Code Overview

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CPT 58240: Pelvic Exenteration for Recurrent or Advanced Cervical Cancer

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References