Summary & Overview
CPT 58291: Vaginal Total Hysterectomy with Bilateral Salpingo-Oophorectomy for Enlarged Uterus
CPT code 58291 represents a vaginal total hysterectomy with bilateral salpingo-oophorectomy performed for an enlarged uterus—commonly due to fibroids—where uterine weight exceeds 250 g. This major gynecologic surgical code signals comprehensive removal of the uterus, cervix, fallopian tubes, and ovaries through a vaginal approach. Nationally, this code matters because it reflects management of symptomatic uterine fibroid disease, impacts surgical setting and resource use, and informs coverage, prior-authorization, and payment policies across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 58291, common sites of service, and the typical service type associated with the procedure. The publication summarizes reimbursement benchmarks where available, highlights recent policy and coding guidance relevant to vaginal hysterectomy for enlarged uteri, and outlines billing considerations and documentation elements that affect claim adjudication. The objective is to provide clinicians, coders, and policy professionals with a clear, national-level reference on the clinical intent and administrative implications of CPT code 58291.
Billing Code Overview
CPT code 58291 describes a surgical procedure in which the physician removes the uterus, cervix, fallopian tubes, and ovaries via a vaginal approach. The procedure is performed when the uterus is larger than normal—typically due to fibroids—resulting in uterine weight greater than 250 g.
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Service type: Major gynecologic surgical procedure (vaginal total hysterectomy with bilateral salpingo-oophorectomy for enlarged uterus)
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Typical site of service: Hospital operating room or ambulatory surgery center with vaginal surgical capabilities
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman with symptomatic uterine fibroids presents with heavy menstrual bleeding, pelvic pressure, and an enlarged uterus on exam and imaging. Conservative therapies, including medical management and uterine-sparing procedures, have failed or are contraindicated. The surgeon determines a vaginal total hysterectomy with bilateral salpingo-oophorectomy for a uterus estimated to weigh >250 g is appropriate. The clinical workflow includes preoperative evaluation (history, pelvic exam, imaging such as transvaginal ultrasound), informed consent addressing removal of the uterus, cervix, fallopian tubes, and ovaries, pre-anesthesia assessment, intraoperative vaginal approach under general or regional anesthesia, surgical removal of the enlarged uterus and adnexa, hemostasis, and postoperative recovery with follow-up for wound healing and symptom resolution. Typical site of service is an inpatient or ambulatory surgical center with gynecologic operating capability; anesthesia services and pathology processing for the specimen are standard components of care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 58291 (document specifics). |