CPT 58263 Vaginal Hysterectomy Reimbursement | OpenPayer

Summary & Overview

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

CPT code 58263 denotes a vaginal hysterectomy with bilateral salpingo-oophorectomy for a uterus of normal size (≤250 g) performed together with repair of an enterocele. This code captures a combined gynecologic surgical intervention addressing uterine removal and pelvic floor support when small bowel prolapses into the vaginal canal. Nationally, accurate coding for this procedure affects surgical quality reporting, bundled payment constructs for gynecologic care, and appropriate assignment of hospital or ambulatory surgical facility resources.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines typical sites of service, service line context, and common clinical indications for use. Readers will find practical benchmarks for utilization and encounter settings, guidance on coding specificity for combined vaginal hysterectomy and enterocele repair, and discussion of implications for claims adjudication and billing workflows. Where input data is not provided, the text notes "Data not available in the input." The content is intended for billing specialists, surgical coders, and policy analysts seeking a concise national overview of CPT code 58263 and its role in gynecologic surgical care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare58263CPTvaginal hysterectomysalpingo-oophorectomyenterocele repairgynecologic surgeryambulatory surgerysurgical coding

Billing Code Overview

CPT code 58263 describes a vaginal hysterectomy with bilateral salpingo-oophorectomy performed for a uterus of normal size (≤250 g) combined with repair of an enterocele (small bowel prolapsing into the vaginal canal). The procedure is a surgical removal of the uterus, cervix, fallopian tubes, and ovaries through a vaginal approach.

Service type: Surgical gynecologic procedure (vaginal hysterectomy with enterocele repair)
Typical site of service: Operative suite in an ambulatory surgical center or hospital operating room, performed under appropriate anesthesia

Clinical & Coding Specifications

Clinical Context

A 58-year-old woman presents with symptomatic pelvic organ prolapse characterized by vaginal bulge, pelvic pressure, and intermittent small-bowel prolapse into the vaginal canal (enterocele). She reports urinary urgency but no active infection. Pelvic exam confirms uterine descent with an associated enterocele and normal-sized uterus (estimated ≤250 g). After conservative measures (pessary, pelvic floor therapy) fail or are declined, the patient elects definitive surgical management: vaginal hysterectomy with enterocele repair. Preoperative workup includes history and physical, pelvic imaging as indicated, labs (CBC, BMP), anesthesia evaluation, and informed consent. The procedure is performed in an operating room with regional or general anesthesia. The surgeon removes the uterus, cervix, fallopian tubes, and ovaries via a vaginal approach and repairs the enterocele defect (e.g., uterosacral ligament suspension or site-specific repair) to restore vaginal support. Postoperative care includes monitoring in PACU, pain control, DVT prophylaxis, and postoperative follow-up for wound healing, voiding, and pelvic support. Typical discharge occurs same day or after an overnight stay depending on comorbidity and intraoperative events.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical requirements documented in the operative report.

CPT 58262: Vaginal Hysterectomy with Bilateral Salpingo-Oophorectomy

CPT-58280-VAGINAL-HYSTERECTOMY-WITH-ENTEROCELE-REPAIR

CPT 58280: Vaginal Hysterectomy with Enterocele Repair

CPT-58275-VAGINAL-HYSTERECTOMY-WITH-VAGINAL-EXCISION

CPT 58275: Vaginal Hysterectomy with Vaginal Excision

CPT-58290-VAGINAL-HYSTERECTOMY-ENLARGED-UTERUS

CPT 58290: Vaginal Hysterectomy for Enlarged Uterus (>250 g)

CPT-58200-ABDOMINAL-HYSTERECTOMY-WITH-LYMPHADENECTOMY

CPT 58200: Abdominal Hysterectomy with Lymphadenectomy

CPT-58150-ABDOMINAL-HYSTERECTOMY-TOTAL-OR-PARTIAL-OOPHORECTOMY

CPT 58150: Abdominal Hysterectomy with Cervix Removal

CPT-58285-RADICAL-HYSTERECTOMY-FOR-CERVICAL-CANCER

CPT 58285: Radical Hysterectomy for Cervical Cancer

CPT-58240-PELVIC-EXENTERATION-MULTI-ORGAN-RESECTION

CPT 58240: Pelvic Exenteration for Recurrent or Advanced Cervical Cancer

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

CPT 58180: Abdominal Hysterectomy, Open Removal of Uterus

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

CPT 58260: Vaginal Hysterectomy, Uterus and Cervix Only

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Taxonomy Code	Specialty	Notes
`207V00000X`	Obstetrics & Gynecology	Gynecologic surgeons commonly perform vaginal hysterectomy and prolapse repairs.
`207VR0400X`	Female Pelvic Medicine & Reconstructive Surgery	Subspecialists who manage complex pelvic organ prolapse and enterocele repairs.
`208000000X`	General Surgery	General surgeons with gynecologic experience may perform hysterectomy in some settings.
`207L00000X`	Gynecologic Oncology	May perform hysterectomy when oncologic concerns are present (uterus normal size in this code makes oncologic indication less likely).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N81.3`	Enterocele	Directly indicates small bowel prolapse into the vaginal canal and is the target of repair during the procedure.
`N81.4`	Uterovaginal prolapse, unspecified	Represents uterine prolapse, a common indication for vaginal hysterectomy.
`N92.0`	Excessive and frequent menstruation with regular cycle	Menorrhagia can be an indication for hysterectomy when conservative therapy fails.
`N93.9`	Abnormal uterine and vaginal bleeding, unspecified	Bleeding disorders may prompt definitive surgical management including hysterectomy.
`I10`	Essential (primary) hypertension	Common comorbidity affecting perioperative risk assessment; often present in the typical patient population.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57425`	Colpopexy, vaginal; repair of enterocele (separate procedure code for vaginal enterocele repair may vary)	May be reported when a distinct vaginal colpopexy or enterocele repair is performed in addition to hysterectomy if not bundled with the primary code per payer policy.
`57240`	Colporrhaphy, repair of cystocele	Commonly performed concomitantly to correct anterior vaginal wall prolapse during vaginal hysterectomy.
`57250`	Colporrhaphy, repair of rectocele	Often performed concurrently to address posterior vaginal wall defects during prolapse repair.
`51702`	Bladder catheterization, simple intermittent	Perioperative bladder catheterization used intraoperatively or postoperatively for retention evaluation.
`99152`	Moderate sedation services provided by the same physician performing a procedure (initial 15 minutes)	May apply if moderate sedation is used instead of general anesthesia for part of perioperative care.
`01560`	Anesthesia for vaginal procedures (example: anesthesia for procedures on the vagina)	Anesthesia codes are reported separately by anesthesia providers when applicable.

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