Summary & Overview
CPT 58555: Diagnostic Hysteroscopy, Uterine Cavity Inspection
CPT code 58555 describes a diagnostic hysteroscopy in which a provider inspects the uterine cavity using a hysteroscope. This code is widely used in gynecologic practice for evaluation of abnormal uterine bleeding, suspected intrauterine lesions, and preoperative assessment. Nationally, accurate coding of hysteroscopy procedures matters for clinical documentation, resource planning, and consistent claims processing across payers.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and payer coverage considerations. The publication also highlights national benchmarks for utilization, recent policy updates affecting coverage and prior authorization practices, and coding nuances that affect billing and claims adjudication.
This summary is intended for billing managers, revenue cycle professionals, and clinical leaders seeking a succinct reference on CPT code 58555, its clinical purpose, and where to look for payer-specific policy details. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 58555 describes a diagnostic procedure in which the provider examines the uterine cavity using a hysteroscope. This procedure is a hysteroscopic uterine cavity inspection performed to evaluate intrauterine pathology such as abnormal bleeding, intrauterine adhesions, polyps, or structural anomalies.
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Service type: Diagnostic hysteroscopy
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in an office setting equipped for hysteroscopy when clinically appropriate.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related procedure codes.
Clinical & Coding Specifications
Clinical Context
A 37-year-old woman presents to the gynecology clinic with abnormal uterine bleeding and suspected intrauterine pathology after transvaginal ultrasound demonstrated a focal endometrial polyp. The patient consents to diagnostic hysteroscopy. In the outpatient ambulatory surgery center, preoperative assessment includes verification of indications, review of prior imaging, informed consent, and anesthesia planning (local, paracervical block, MAC, or general anesthesia as appropriate). The provider performs endocervical dilation as needed, introduces a hysteroscope to visualize the uterine cavity, inspects the endometrium, tubal ostia, and intrauterine lesions, documents findings with images or video, and may take directed biopsies or plan operative hysteroscopy at a later date if resection is required. Postprocedure recovery includes monitoring for bleeding or pain, discharge instructions, and documentation of operative note and pathology orders if tissue was obtained.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the day of a procedure | Use when a separate evaluation and management visit is performed the same day as hysteroscopy and meets E/M criteria. |
51 |