CPT 58294 Vaginal Hysterectomy Reimbursement | OpenPayer

Summary & Overview

CPT 58294: Vaginal Hysterectomy for Enlarged Uterus with Bowel Repair

CPT code 58294 denotes a vaginal hysterectomy involving removal of the uterus and cervix via a vaginal approach when the uterus is enlarged (commonly from fibroids) and weighs more than 250 grams, with concurrent repair for small bowel prolapsing into the vaginal canal. This code captures a complex gynecologic surgical service that combines organ removal and pelvic organ repair, and it is relevant to hospitals, ambulatory surgery centers, surgeons, and payers because it affects surgical coding, facility planning, and reimbursement for higher-acuity gynecologic procedures.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical scenario covered by the code, where the service is typically performed, and what aspects influence coding and utilization. The publication provides benchmarks and payment context where available, clinical context about indications (enlarged uterus and prolapsed small bowel into the vaginal canal), and notes on common billing modifiers when applicable. The content is structured to help coding professionals, billing administrators, and policy analysts understand the code’s clinical scope and operational implications on a national level.

Data not available in the input: associated taxonomies, specific ICD-10 diagnosis mappings, payer-specific fee schedules, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 58294vaginal hysterectomygynecologic surgerypelvic organ prolapse repairenlarged uterusfibroidssurgical codingambulatory surgery

Billing Code Overview

CPT code 58294 describes a vaginal hysterectomy with removal of the uterus and cervix only performed surgically via a vaginal approach. The procedure includes repair of small bowel prolapsing into the vaginal canal and applies when the uterus is enlarged (typically due to fibroids) with an estimated weight greater than 250 grams.

Service Type: Major gynecologic surgical procedure — vaginal hysterectomy with concurrent pelvic organ repair

Typical Site of Service: Hospital operating room or ambulatory surgery center (inpatient or outpatient surgical setting depending on clinical factors and payer policies)

Clinical & Coding Specifications

Clinical Context

A 52-year-old woman presents with symptomatic uterine fibroids causing heavy menstrual bleeding and bulk symptoms. Pelvic exam and imaging confirm a bulky, enlarged uterus estimated >250 grams and associated symptomatic pelvic organ prolapse with small bowel (enterocele) prolapsing into the vaginal canal. After conservative measures fail, the patient is scheduled for a vaginal hysterectomy with removal of the cervix and concurrent repair of the vaginal cuff and enterocele. The clinical workflow includes preoperative evaluation (history, pelvic exam, imaging, labs), informed consent discussing vaginal approach risks and benefits, anesthesia (typically general or regional), vaginal surgical removal of the uterus and cervix, repair of small bowel prolapse and support of the vaginal apex, hemostasis, post-anesthesia recovery, and short inpatient or same-day discharge monitoring depending on clinical status and comorbidities. Typical site of service is an operating room within a hospital or ambulatory surgery center. Service type is a major gynecologic surgical procedure performed via a vaginal approach for benign uterine enlargement with concomitant pelvic floor repair.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, and intensity significantly exceed typical for the procedure (document rationale).

CPT 58240: Pelvic Exenteration for Recurrent or Advanced Cervical Cancer

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

CPT 58280: Vaginal Hysterectomy with Enterocele Repair

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

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

CPT-58291-VAGINAL-TOTAL-HYSTERECTOMY-BILATERAL-SALPINGO-OOPHORECTOMY-ENLARGED-UTERUS

CPT 58291: Vaginal Total Hysterectomy with Bilateral Salpingo-Oophorectomy for Enlarged Uterus

CPT-58200-ABDOMINAL-HYSTERECTOMY-WITH-LYMPHADENECTOMY

CPT 58200: Abdominal Hysterectomy with Lymphadenectomy

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

CPT 58285: Radical Hysterectomy for Cervical Cancer

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

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Taxonomy Code	Specialty	Notes
207V00000X	Obstetrics & Gynecology	Board-certified gynecologists perform hysterectomy and pelvic floor repairs.
207VC0000X	Gynecologic Oncology	Gynecologic oncologists may perform complex hysterectomies for enlarged uteri or suspected malignancy.
207VP0002X	Female Pelvic Medicine & Reconstructive Surgery	Specialists in pelvic floor disorders frequently perform vaginal prolapse and enterocele repairs.
208000000X	General Surgery	General surgeons may be involved in complex intra-abdominal adhesiolysis or bowel repair if encountered.
363L00000X	Certified Registered Nurse Anesthetist	Provides anesthesia services in operative settings; taxonomy listed for perioperative team.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N84.1`	Uterine leiomyoma, submucous	Fibroids are a common reason for enlarged uterus and hysterectomy.
`N84.0`	Uterine leiomyoma, intramural	Intramural fibroids contribute to uterine enlargement >250 g prompting hysterectomy.
`N81.4`	Vaginal vault prolapse (enterocele)	Small bowel prolapse into the vaginal canal is repaired during the procedure.
`N81.3`	Rectocele	Posterior compartment defects often addressed concurrently with pelvic repair.
`N81.2`	Cystocele	Anterior compartment defects may be repaired in the same operative session.
`N93.8`	Other specified abnormal uterine and vaginal bleeding	Abnormal bleeding can be an indication for hysterectomy when conservative care fails.
`D25.9`	Leiomyoma of uterus, unspecified	General code for fibroid disease associated with enlarged uterus.
`K62.4`	Rectal prolapse	May be evaluated or addressed if present with complex pelvic organ prolapse.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`58150`	Total abdominal hysterectomy (corpus and cervix), abdominal approach	Alternative approach if vaginal route not feasible or if abdominal access required for enlarged uterus.
`58260`	Vaginal hysterectomy, for uterus 250 g or less	Similar vaginal approach code used when uterus weight is <=250 g; `58294` applies when uterus >250 g.
`57260`	Colporrhaphy, anterior	Used when an anterior vaginal wall (cystocele) repair is performed concurrently.
`57270`	Colporrhaphy, posterior	Used for posterior vaginal wall (rectocele) repair performed at same operative session.
`57425`	Colposcopy with biopsy	May be performed preoperatively if abnormal cervical pathology requires evaluation prior to hysterectomy.
`49999`	Unlisted procedure, abdomen, peritoneum, and omentum	Used only if an unexpected, non-listed intra-abdominal procedure is required; document reason and submit operative report.

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