CPT 58805 Ovarian Cyst Drainage Reimbursement | OpenPayer

Summary & Overview

CPT 58805: Ovarian Cyst Drainage via Abdominal Incision

CPT code 58805 identifies a surgical ovarian cyst drainage performed through an abdominal incision. This procedure is used to evacuate fluid or contents from one or more ovarian cysts and may be performed for symptom relief, management of adnexal masses, or to obtain diagnostic material. As an operative gynecologic service, it can be delivered in hospital operating rooms or ambulatory surgical centers and may have implications for surgical utilization, postoperative care, and procedural coding accuracy nationally.

Key payers in national coverage and billing discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, common sites of service, and the categories of payers typically involved in coverage and reimbursement decisions.

This publication provides benchmarks and operational guidance on coding and billing practices associated with CPT code 58805, summarizes relevant policy considerations and payer coverage patterns, and contextualizes the procedure within surgical gynecology. It highlights points pertinent to claims submission, documentation needs, and typical care settings, and it flags areas where input data was not available.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 58805ovarian cyst drainagegynecologic surgeryopen abdominal procedureoperative billingsurgical codingambulatory surgical centerhospital operating roomprocedural documentation

Billing Code Overview

CPT code 58805 describes a surgical procedure in which a provider drains one or more ovarian cysts from one or more ovaries through an abdominal incision. The procedure is a form of operative gynecologic intervention aimed at removing cystic fluid or contents to relieve symptoms, address mass effect, or obtain diagnostic material.

Service Type: Surgical procedure — gynecologic, open abdominal approach

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

Clinical & Coding Specifications

Clinical Context

A 34-year-old female presents to the hospital with acute, unilateral lower abdominal pain and an adnexal mass seen on pelvic ultrasound consistent with a complex ovarian cyst. She is hemodynamically stable but reports escalating pain and limited oral intake. After consultation with gynecology, the decision is made to perform surgical drainage of the ovarian cyst via an open transabdominal approach due to cyst size, adhesions suspected on imaging, and prior abdominal surgery. Preoperative steps include history and physical, informed consent, pregnancy test, basic labs, and perioperative prophylactic antibiotics. In the operating room under general anesthesia, an abdominal incision is made, the ovary is exteriorized, and one or more cysts are aspirated or drained with hemostasis achieved. The specimen may be sent to pathology if indicated. Postoperative care includes routine recovery unit monitoring, pain control, wound care, and follow-up in gynecology clinic for pathology review and fertility counseling if relevant.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for `58805` (document rationale).
`23`

CPT 58822: Ovarian Abscess Drainage via Abdominal Incision

CPT-58820-OVARIAN-ABSCESS-DRAINAGE-VAGINAL-APPROACH

CPT 58820: Ovarian Abscess Drainage via Vaginal Wall Incision

CPT-58825-OVARIAN-TRANSPOSITION-OPEN-ABDOMINAL

CPT 58825: Ovarian Transposition via Abdominal Incision

CPT-58800-TRANSVAGINAL-OVARIAN-CYST-DRAINAGE

CPT 58800: Transvaginal Drainage of Ovarian Cyst(s)

Taxonomy Code	Specialty	Notes
207V00000X	Obstetrics & Gynecology	Gynecologic surgeons and general OB/GYNs commonly perform ovarian cyst drainage.
2080P0006X	General Surgery	General surgeons may perform abdominal approaches when gynecologic subspecialty is not available or diagnosis unclear.
207VP0800X	Gynecologic Oncology	Gynecologic oncologists manage complex cysts, suspicious masses, or malignancy risk.
2086S0122X	Minimally Invasive Gynecologic Surgery	Surgeons performing laparoscopy may convert to open drainage and also manage cyst drainage.
363L00000X	Reproductive Endocrinology/Infertility	Specialists involved when fertility-sparing management is a concern.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N83.0`	Follicular cyst of ovary	Common benign cyst that may be drained if symptomatic or large.
`N83.2`	Hemorrhagic ovarian cyst	May cause acute pain and require drainage if persistent or complicated.
`N83.1`	Parovarian cyst	Adnexal cyst adjacent to the ovary that can present similarly and be drained.
`N83.3`	Ovarian cyst, unspecified	General code when cyst type is not specified preoperatively.
`N83.4`	Rupture of ovarian cyst	May necessitate operative drainage if causing hemoperitoneum or ongoing symptoms.
`N83.5`	Torsion of ovary	Although primary management is detorsion, associated cyst drainage may occur intraoperatively.
`R10.2`	Pelvic and perineal pain	Symptom code commonly accompanying ovarian cysts and justification for intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`58662`	Laparoscopy, surgical; with fulguration of oviducts (with or without transection)	May be performed in the same operative setting if laparoscopic exploration or tubal procedures are indicated in conjunction with ovarian cyst management.
`58611`	Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy)	Performed when cyst characteristics or intraoperative findings necessitate oophorectomy rather than simple drainage.
`49000`	Exploratory laparotomy, exploratory abdominal incision for diagnosis (separate procedure)	May precede or accompany open ovarian cyst drainage when intra-abdominal exploration is required.
`58999`	Unlisted procedure, female genital system (specify)	Used if a specific drainage technique or adjunct procedure is not described by existing codes; requires documentation and operative report.
`76830`	Ultrasound, transvaginal	Preoperative or intraoperative imaging used to characterize cysts and guide management; commonly performed before `58805`.

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