CPT 58563: Hysteroscopic Endometrial Ablation

Medicare pays $2099 and commercial payers pay $3296 on average nationally for this procedure.

CPT code 58563 describes a hysteroscopically guided endometrial ablation in which the provider destroys the uterine lining to treat abnormal uterine bleeding; service type: operative gynecologic procedure; typical site of service: hospital outpatient department or ambulatory surgical center.

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National Reimbursement Benchmarks

National means place Blue Cross Blue Shield well above Medicare and BUCA: Blue Cross Blue Shield’s mean rate is $4,558.90 versus BUCA’s average commercial mean of $3,296.10 and Medicare’s mean of $2,098.90. That positions Medicare roughly $1,197.20 below BUCA and $2,460.00 below Blue Cross Blue Shield on mean reimbursement for CPT 58563, indicating a tiered environment where Medicare sits below average commercial levels and Blue Cross Blue Shield pays materially more than both.

Dispersion measured by the interquartile range (P75−P25) varies noticeably by payer. Blue Cross Blue Shield shows the widest IQR at $4,884.20, followed by UnitedHealth Group at $2,593.50 and Cigna at $2,320.60, reflecting higher variability in commercial contracts. Aetna is much tighter with an IQR of $1,346.40, and BUCA’s IQR is $3,686.50; Medicare’s IQR is the narrowest at $281.00, indicating the most consistent locality-adjusted payments among the listed payers.

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CPT 58563: Hysteroscopic Endometrial Ablation

Medicare pays $2099 and commercial payers pay $3296 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 58563 policy alerts

Get alerted when payer policies referencing 58563 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 42-year-old woman presents to a gynecology clinic with a 12–18 month history of heavy, irregular menstrual bleeding refractory to medical management (combined oral contraceptives and tranexamic acid). Endometrial biopsy has ruled out hyperplasia or malignancy. After counseling, she is scheduled for a hysteroscopic endometrial ablation to definitively treat abnormal uterine bleeding. The procedure is performed in an outpatient ambulatory surgery center under monitored anesthesia care or general anesthesia. A hysteroscope is inserted transcervically to visualize the uterine cavity; the device energy source (e.g., electrosurgical, thermal, or radiofrequency) is used to ablate and destroy the endometrial lining. Typical peri-procedural workflow includes preoperative consent and history/physical, verification of pathology results, anesthesia evaluation, intraoperative hysteroscopic ablation, brief post-anesthesia recovery, and discharge with analgesics and post-op instructions. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`58353`	Endometrial ablation, thermal, without hysteroscopic guidance	Alternative ablation technique when hysteroscopic visualization is not used
`58565`	Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants	Different hysteroscopic surgical procedure that may be performed during the same gynecologic visit for tubal occlusion
`64435`	Injection, anesthetic agent; paracervical (uterine) nerve	Local anesthetic technique that may be used adjunctively for perioperative analgesia during hysteroscopic procedures

Related Modifiers

9 rows

Modifier	Description	When to Use
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
47	Modifier -47 (“Anesthesia by Surgeon”) is appended to a surgical or procedural CPT code when the surgeon personally provides regional or general anesthesia for the procedure. Use of -47 indicates the…	- Use modifier -47 when the surgeon personally provides regional or general anesthesia during the surgical procedure (i.e., the surgeon administers the anesthesia in addition to performing the…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207VG0400X	Gynecology Physician	A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions.
207V00000X	Obstetrics & Gynecology Physician	An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproducti…
207VX0000X	Obstetrics Physician	A physician who specializes in diagnosis, treatment, and management of patients with obstetric conditions.
152WS0006X	Sports Vision Optometrist	An optometrist who offers services designed to care for unique vision care needs of athletes, which may include one of more of the following services:…
207N00000X	Dermatology Physician	A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genital…
364SP2800X	Perioperative Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
364SW0102X	Women's Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
208200000X	Plastic Surgery Physician	A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal sys…

Related Payer Policy Updates

Specialty: General Surgery1 / 2

10 rows

Policy	Payer	Effective Date
Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults	Premera Bluecross	2026-09-01
Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in Adults	Premera Bluecross	2026-09-01
Site of Service Ambulatory Service Center (ASC) Select	Premera Bluecross	2026-09-01
Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)	Premera Bluecross	2026-09-01
Site of Service Ambulatory Service Center (ASC) Select	Premera Bluecross	2026-09-01
Outpatient Surgical Procedures - Site of Service	sierra health and life	2026-08-01
Medical Necessity Guidelines — Inpatient Surgical Care	Mass General Brigham Health Plan	2026-08-01
Ambulatory Surgery Center (ASC) - Site of Care Policy	Kaiser Permanente	2026-08-01
Inpatient Surgical Site of Service	Providence Health Plan	2026-07-01
Removal of Implantable Devices	Blue Cross Blue Shield - Rhode Island	2026-07-01

CPT 58541: Laparoscopic Subtotal Hysterectomy (Cervix Preserved)

CPT-58542-LAPAROSCOPIC-SUBTOTAL-HYSTERECTOMY-SUPRACERVICAL

CPT 58542: Laparoscopic Supracervical Hysterectomy, Normal-Size Uterus

CPT-58543-LAPAROSCOPIC-SUBTOTAL-HYSTERECTOMY-ENLARGED-UTERUS

CPT 58543: Laparoscopic Subtotal Hysterectomy for Enlarged Uterus

CPT-58544-LAPAROSCOPIC-SUPRACERVICAL-HYSTERECTOMY-ENLARGED-UTERUS

CPT 58544: Laparoscopic Supracervical Hysterectomy for Enlarged Uterus

CPT-58545-LAPAROSCOPIC-MYOMECTOMY-1-TO-4-FIBROIDS-UP-TO-250G

CPT 58545: Laparoscopic Myomectomy, 1–4 Fibroids (≤250 g)

CPT-58546-LAPAROSCOPIC-MYOMECTOMY-MULTIPLE-OR-MASSIVE-FIBROIDS

CPT 58546: Laparoscopic Myomectomy, ≥5 Fibroids or >250 g

CPT-58548-LAPAROSCOPIC-RADICAL-HYSTERECTOMY-BSO-PELVIC-LYMPHADENECTOMY

CPT 58548: Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy

CPT-58550-LAPAROSCOPIC-ASSISTED-VAGINAL-HYSTERECTOMY-NORMAL-UTERUS

CPT 58550: Laparoscopic-Assisted Vaginal Hysterectomy for Normal-Size Uterus

CPT-58552-VAGINAL-HYSTERECTOMY-WITH-LAPAROSCOPIC-ASSISTANCE

CPT 58552: Laparoscopic-Assisted Vaginal Hysterectomy, Normal-Size Uterus

CPT-58553-LAPAROSCOPICALLY-ASSISTED-VAGINAL-HYSTERECTOMY-ENLARGED-UTERUS

CPT 58553: Vaginal Hysterectomy with Laparoscopic Assistance for Enlarged Uterus

Showing 1–10 of 25

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`58353`	Endometrial ablation, thermal, without hysteroscopic guidance	Alternative ablation technique when hysteroscopic visualization is not used
`58565`	Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants	Different hysteroscopic surgical procedure that may be performed during the same gynecologic visit for tubal occlusion
`64435`	Injection, anesthetic agent; paracervical (uterine) nerve	Local anesthetic technique that may be used adjunctively for perioperative analgesia during hysteroscopic procedures

Related Modifiers

9 rows

Modifier	Description	When to Use
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
47	Modifier -47 (“Anesthesia by Surgeon”) is appended to a surgical or procedural CPT code when the surgeon personally provides regional or general anesthesia for the procedure. Use of -47 indicates the…	- Use modifier -47 when the surgeon personally provides regional or general anesthesia during the surgical procedure (i.e., the surgeon administers the anesthesia in addition to performing the…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207VG0400X	Gynecology Physician	A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions.
207V00000X	Obstetrics & Gynecology Physician	An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproducti…
207VX0000X	Obstetrics Physician	A physician who specializes in diagnosis, treatment, and management of patients with obstetric conditions.
152WS0006X	Sports Vision Optometrist	An optometrist who offers services designed to care for unique vision care needs of athletes, which may include one of more of the following services:…
207N00000X	Dermatology Physician	A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genital…
364SP2800X	Perioperative Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
364SW0102X	Women's Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
208200000X	Plastic Surgery Physician	A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal sys…

Related Payer Policy Updates

Specialty: General Surgery1 / 2

10 rows

Policy	Payer	Effective Date
Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults	Premera Bluecross	2026-09-01
Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in Adults	Premera Bluecross	2026-09-01
Site of Service Ambulatory Service Center (ASC) Select	Premera Bluecross	2026-09-01
Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)	Premera Bluecross	2026-09-01
Site of Service Ambulatory Service Center (ASC) Select	Premera Bluecross	2026-09-01
Outpatient Surgical Procedures - Site of Service	sierra health and life	2026-08-01
Medical Necessity Guidelines — Inpatient Surgical Care	Mass General Brigham Health Plan	2026-08-01
Ambulatory Surgery Center (ASC) - Site of Care Policy	Kaiser Permanente	2026-08-01
Inpatient Surgical Site of Service	Providence Health Plan	2026-07-01
Removal of Implantable Devices	Blue Cross Blue Shield - Rhode Island	2026-07-01

CPT 58541: Laparoscopic Subtotal Hysterectomy (Cervix Preserved)

CPT-58542-LAPAROSCOPIC-SUBTOTAL-HYSTERECTOMY-SUPRACERVICAL

CPT 58542: Laparoscopic Supracervical Hysterectomy, Normal-Size Uterus

CPT-58543-LAPAROSCOPIC-SUBTOTAL-HYSTERECTOMY-ENLARGED-UTERUS

CPT 58543: Laparoscopic Subtotal Hysterectomy for Enlarged Uterus

CPT-58544-LAPAROSCOPIC-SUPRACERVICAL-HYSTERECTOMY-ENLARGED-UTERUS

CPT 58544: Laparoscopic Supracervical Hysterectomy for Enlarged Uterus

CPT-58545-LAPAROSCOPIC-MYOMECTOMY-1-TO-4-FIBROIDS-UP-TO-250G

CPT 58545: Laparoscopic Myomectomy, 1–4 Fibroids (≤250 g)

CPT-58546-LAPAROSCOPIC-MYOMECTOMY-MULTIPLE-OR-MASSIVE-FIBROIDS

CPT 58546: Laparoscopic Myomectomy, ≥5 Fibroids or >250 g

CPT-58548-LAPAROSCOPIC-RADICAL-HYSTERECTOMY-BSO-PELVIC-LYMPHADENECTOMY

CPT 58548: Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy

CPT-58550-LAPAROSCOPIC-ASSISTED-VAGINAL-HYSTERECTOMY-NORMAL-UTERUS

CPT 58550: Laparoscopic-Assisted Vaginal Hysterectomy for Normal-Size Uterus

CPT-58552-VAGINAL-HYSTERECTOMY-WITH-LAPAROSCOPIC-ASSISTANCE

CPT 58552: Laparoscopic-Assisted Vaginal Hysterectomy, Normal-Size Uterus

CPT-58553-LAPAROSCOPICALLY-ASSISTED-VAGINAL-HYSTERECTOMY-ENLARGED-UTERUS

CPT 58553: Vaginal Hysterectomy with Laparoscopic Assistance for Enlarged Uterus

Showing 1–10 of 25

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 58563: Hysteroscopic Endometrial Ablation

Sign up for cpt 58563 policy alerts

National Reimbursement Benchmarks

OpenPayer

CPT 58563: Hysteroscopic Endometrial Ablation

Sign up for cpt 58563 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

CPT 58563: Hysteroscopic Endometrial Ablation

Sign up for cpt 58563 policy alerts

National Reimbursement Benchmarks

CPT 58563: Hysteroscopic Endometrial Ablation

Sign up for cpt 58563 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does CPT 58563 represent and where is it usually performed?

Which payers are included in the reimbursement benchmarks for CPT 58563 and how do they compare?

What are the key reimbursement benchmark findings for CPT 58563?

Which modifiers and provider taxonomies are relevant when coding CPT 58563?

What clinical context, workflow, and related codes/diagnoses are associated with CPT 58563?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does CPT 58563 represent and where is it usually performed?

Which payers are included in the reimbursement benchmarks for CPT 58563 and how do they compare?

What are the key reimbursement benchmark findings for CPT 58563?

Which modifiers and provider taxonomies are relevant when coding CPT 58563?

What clinical context, workflow, and related codes/diagnoses are associated with CPT 58563?

References