CPT 58292 Vaginal Hysterectomy Reimbursement

CPT code 58292 represents a vaginal hysterectomy with removal of the uterus and cervix plus bilateral salpingo-oophorectomy, combined with repair of small bowel prolapse into the vaginal canal for an enlarged uterus typically exceeding 250 grams (often due to fibroids). Nationally, this code captures a complex gynecologic procedure that intersects surgical, obstetric-gynecology, and pelvic reconstructive care pathways and can have implications for surgical setting, resource utilization, and post-operative care coordination.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service expectations, payer coverage considerations, and benchmarking areas relevant to utilization and site-of-service decisions. The publication highlights common clinical scenarios tied to the code, factors that influence whether the procedure is performed in an ambulatory surgical center versus inpatient setting, and areas where coding specificity affects claims processing and audit risk.

This summary provides actionable reference material for coding accuracy, payer discussions, and administrative planning without offering clinical recommendations. Data not available in the input is noted where applicable in the full publication.

Billing Code Overview

CPT code 58292 describes a surgical procedure in which the physician performs a vaginal hysterectomy with removal of the uterus and cervix plus bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries). The procedure includes repair of small bowel prolapse into the vaginal canal and is specified for a uterus enlarged beyond normal size, typically weighing more than 250 grams, often due to fibroids.

Service type: Major gynecologic surgery (vaginal hysterectomy with bilateral salpingo-oophorectomy and pelvic floor/enteric repair)
Typical site of service: Inpatient or ambulatory surgical center depending on clinical status and procedural complexity; performed through a vaginal approach under operative setting

Clinical Context

A 52-year-old female with symptomatic uterine fibroids and pelvic organ prolapse presents for definitive surgical management. She reports heavy menstrual bleeding, pelvic pressure, and recent vaginal bulge with intermittent small bowel prolapse into the vaginal canal. Imaging and exam confirm a uterine mass consistent with fibroids resulting in uterine size >250 grams and concomitant enterocele. The surgical plan is a vaginal hysterectomy with bilateral salpingo-oophorectomy and concurrent repair of the small bowel prolapse (enterocoele repair). The patient undergoes preoperative assessment, informed consent, perioperative antibiotics, standard anesthesia, and postoperative inpatient observation with analgesia and venous thromboembolism prophylaxis. Follow-up visits include wound evaluation, activity restrictions, and pathology review of the surgical specimen.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for this procedure (extensive adhesiolysis or additional repairs).
`23`	Unusual anesthesia	Use if a typically general/anesthetic procedure is performed under general anesthesia due to patient condition when anesthesia is otherwise not typical.

Taxonomy Code	Specialty	Notes
207V00000X	Obstetrics & Gynecology	Gynecologic surgeons who perform hysterectomy and pelvic floor repairs.
207VC0200X	Gynecologic Oncology	Surgeons managing complex uterine masses or when malignancy is a concern.
208800000X	General Surgery	Surgeons who may assist with complex intra-abdominal adhesions or bowel injury repair.
207L00000X	Female Pelvic Medicine & Reconstructive Surgery	Specialists who perform advanced pelvic organ prolapse and enterocele repairs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N92.0`	Excessive and frequent menstruation with regular cycle	Common indication for hysterectomy for symptomatic fibroids causing heavy bleeding.
`N80.0`	Endometriosis of uterus	Can be associated with pelvic pain and may contribute to surgical planning for hysterectomy.
`N83.2`	Hemorrhagic ovarian cyst	May prompt adnexal removal (oophorectomy) at the time of hysterectomy.
`N84.0`	Polyp of corpus uteri	Uterine pathology sometimes found with abnormal uterine bleeding and hysterectomy.
`N81.6`	Enterocele	Direct diagnosis for small bowel prolapse into the vaginal canal requiring repair concurrent with hysterectomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57260`	Vaginal repair of enterocele (separate procedure)	May be performed concurrently or as part of pelvic support repair for small bowel prolapse into the vaginal canal.
`58150`	Total abdominal hysterectomy, performed through abdominal incision	Alternative approach when vaginal hysterectomy is not feasible due to uterine size or anatomy.
`58262`	Laparoscopy, surgical; with removal of uterus, with total hysterectomy, with or without removal of tubes/ovaries	Minimally invasive alternative when vaginal approach is not appropriate, or for concurrent laparoscopic evaluation.
`58661`	Laparoscopic adnexal procedures, e.g., oophorectomy	May be used if adnexal removal is performed laparoscopically rather than vaginally.
`49000`	Exploratory laparotomy, exploratory abdominal surgery	Used if conversion to open abdominal surgery is required for unexpected findings such as extensive adhesions or bowel involvement.

OpenPayer

Summary & Overview

CPT 58292: Vaginal Hysterectomy with BSO and Small Bowel Repair