Summary & Overview
CPT 58553: Laparoscopically Assisted Vaginal Hysterectomy for Enlarged Uterus
CPT code 58553 denotes a laparoscopically assisted vaginal hysterectomy: removal of the uterus and cervix through the vagina with laparoscopic division of upper uterine attachments, indicated for an enlarged uterus (weight >250 g), commonly for fibroid-related symptoms. Nationally, hysterectomy remains a high-volume gynecologic procedure with significant implications for surgical practice patterns, site-of-service decisions, and payer coverage policies.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, expected sites of service, and benchmarking context for utilization and coverage considerations. The publication highlights common coding relationships and modifiers used with this surgical code, comparative payer approaches to site-of-service and inpatient versus outpatient determinations, and clinical context related to uterus size thresholds that affect code selection.
This summary provides clinicians, billing professionals, and policy analysts with the essential facts about CPT code 58553, what drives its medical necessity, and what aspects commonly influence reimbursement and utilization nationally. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 58553 describes a vaginal hysterectomy in which the provider removes the uterus and cervix through the vagina while using a laparoscope to access the abdomen and divide the upper uterine attachments. This approach is intended for treatment of fibroids when the uterus is larger than normal (weighing more than 250 g).
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Service type: Surgical procedure — laparoscopically assisted vaginal hysterectomy for an enlarged uterus
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Typical site of service: Hospital operating room or ambulatory surgery center where operative laparoscopy and vaginal surgery are performed
Clinical & Coding Specifications
Clinical Context
A 48-year-old female presents with symptomatic uterine fibroids causing heavy menstrual bleeding, pelvic pressure, and anemia. Conservative treatments including medical management and uterine-sparing procedures were attempted without durable relief. Imaging and exam indicate a markedly enlarged uterus estimated to exceed 250 g. The surgical plan is a laparoscopically assisted vaginal hysterectomy to remove the uterus and cervix via the vaginal approach while using laparoscopy to divide upper uterine attachments and perform adnexal evaluation.
Preoperative workflow includes history and physical, assessment of surgical risk, informed consent, preoperative labs (CBC, type and screen), and anesthesia evaluation. Intraoperative workflow involves general anesthesia, laparoscopy for visualization and division of uterine pedicles, vaginal delivery of the uterus, hemostasis, and optional salpingo-oophorectomy if indicated. Postoperative workflow includes recovery monitoring, pain control, discharge instructions, and follow-up for pathology and wound/healing assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or intensity substantially exceeds typical for a vaginal hysterectomy due to adhesions or enlarged uterus. |