CPT code 58260 – Vaginal hysterectomy, uterus 250g or less

Key takeaways

CPT code 58260 covers a vaginal hysterectomy for a uterus weighing 250 g or less, with no laparoscopic or robotic assistance.

The operative note or pathology report must record specimen weight, because without it the payer cannot tell 58260 from 58290.

Removing a tube or ovary moves the case to 58262, and billing 58260 for it misstates the procedure on the claim.

Medicare’s 2026 national payment for 58260 is about $741.83, built on 13.80 work RVUs and a 90-day global period.

Pabau’s claims management software validates each claim for missing or invalid details before it reaches the clearinghouse.

CPT code 58260: Official descriptor and clinical definition

CPT code 58260 is defined by the American Medical Association as: Vaginal hysterectomy, for uterus 250 g or less. Three elements must be true simultaneously for 58260 to apply:

• Approach: strictly vaginal, without laparoscopic or robotic assistance at any point in the procedure
• Uterine weight: specimen weight of 250 grams or less, confirmed by pathology report or documented surgical estimate
• Scope: uterus only – no removal of fallopian tubes or ovaries

The code carries a global surgical period of 90 days under the Medicare Physician Fee Schedule. All routine pre- and postoperative visits within that window are bundled into the base payment. Place of service may be hospital inpatient (POS 21), on-campus hospital outpatient (POS 22), or an ambulatory surgical center (POS 24).

What CPT code 58260 includes and excludes

Understanding the surgical scope bundled into 58260 prevents both undercoding and overbilling errors. The procedure encompasses colpotomy, uterine mobilization, ligation of vascular pedicles, and vaginal cuff closure.

Included (cannot be billed separately):

• Colpotomy (entry into the vaginal vault)
• Uterine mobilization and delivery
• Ligation of broad ligament and uterine vessels
• Vaginal cuff closure
• Routine preoperative and postoperative visits within the 90-day global period

Not included (may be separately reportable with correct modifier or code):

• Removal of tubes and/or ovaries (code to 58262 or 58263 instead of 58260)
• Colporrhaphy, anterior or posterior repair (CPT 57240, 57250)
• Cystoscopy or cystourethroscopy (CPT 52000)
• Sling operation for stress incontinence (CPT 57288)
• Laparoscopic assistance at any stage (recode to 58550-58554 or 58570-58573)
• Robotic-assisted approach (reported with the laparoscopic codes, never 58260)

CPT 58260 vs. related hysterectomy codes

Three questions settle the code. Was the approach entirely vaginal, did the uterus weigh 250 g or less, and were the tubes and ovaries left in place? The decision path below runs them in the order a coder meets them in the operative note.

The table maps each neighboring code by approach, uterine weight, and adnexal scope.

Robotic approach: CPT code 58260 never covers a robotic-assisted hysterectomy. Robotic cases are reported with the standard laparoscopic codes, such as 58571 for a total laparoscopic hysterectomy with tube or ovary removal. CPT has no separate robotic hysterectomy code, so submitting 58260 for a robotic procedure misreports the approach.

Documentation requirements for CPT code 58260

A 58260 claim stands or falls on the operative report. It must establish each defining criterion before the claim is submitted.

The operative note must explicitly state:

• Surgical approach: confirmation that the procedure was performed entirely via the vaginal route, with no laparoscopic ports placed and no robotic system engaged
• Specimen weight: uterine specimen weight of 250 g or less, supported by a pathology report or a surgeon estimate documented at the time of removal
• Adnexal status: explicit notation that the tubes and ovaries were left in place. If either was removed, the case moves from 58260 to 58262.
• Primary ICD-10-CM diagnosis: a valid, current-year code supporting medical necessity (see the paired diagnosis table below)
• Place of service: inpatient, outpatient, or ASC, which determines the applicable facility rate

A superbill documentation workflow that captures specimen weight at the time of surgery keeps many 58260 claims from being reviewed or recoded later.

ICD-10-CM diagnosis codes commonly paired with CPT code 58260

Every 58260 claim requires a primary ICD-10-CM diagnosis code establishing medical necessity. The following diagnoses appear most frequently alongside this procedure code.

Modifiers for CPT 58260

The applicable modifiers for CPT 58260 depend on case complexity, concurrent procedures, and payer requirements. Using a modifier without adequate documentation is as problematic as omitting one that applies.

Modifier -50 (bilateral) does not apply to hysterectomy. Modifier -22 should not be appended routinely. Payers scrutinize it closely, and repeated use without substantive documentation invites an audit.

Medicare reimbursement and fee schedule for CPT code 58260

Medicare reimbursement for CPT code 58260 is based on the annual CMS Physician Fee Schedule. Rates vary by place of service and geographic locality. The figures below are 2026 national amounts before locality adjustment. Use the CMS fee schedule lookup to confirm the rate for your ZIP code.

Commercial payers set their own fee schedules, often expressed as a percentage of Medicare. Prior authorization requirements vary widely. Traditional Medicare does not require prior authorization for an inpatient vaginal hysterectomy.

Commercial payers such as UnitedHealthcare, Aetna, and BCBS plans may require it in both inpatient and outpatient settings. Verify benefits individually before scheduling.

NCCI bundling rules for CPT 58260

National Correct Coding Initiative (NCCI) edits define which procedure codes count as components of 58260. Those codes cannot be billed on the same date without a modifier documenting a distinct service.

Misreading the edits causes two opposite errors. Unbundling bills a component separately when it should not be billed. The reverse error leaves a distinct same-day service, such as a 57288 sling procedure, unbilled.

Always verify current NCCI edit pairs against the CMS NCCI tables before submitting. Edit pairs are updated quarterly, so a bundling rule that applied last year may have changed.

Common denial reasons for CPT 58260 and how to avoid them

Most 58260 denials trace to a small set of preventable errors. Each denial reason below maps to a specific corrective action that can be built into the billing workflow before the claim leaves the practice.

• Specimen weight not documented: The operative or pathology report does not confirm the uterus weighed 250 g or less. The payer cannot confirm 58260 over 58290, so it denies the claim or requests records. Fix: make specimen weight a mandatory field in the operative template before the chart closes.
• Wrong approach coded: Laparoscopic-assisted case submitted as CPT 58260 (vaginal only). This misreports the approach and is a common audit risk. Fix: the operative report’s approach field must separate entirely vaginal from laparoscopic-assisted cases. Coders should escalate any ambiguity to the surgeon before the claim goes out.
• Adnexal removal not separately coded: Tubes or ovaries were removed but 58260 was submitted instead of 58262, so the claim misstates the procedure. Fix: add an adnexal status checkbox to the post-op charge capture form.
• Missing or invalid ICD-10-CM diagnosis: The claim has no primary diagnosis code, or its code does not support medical necessity for hysterectomy. Fix: cross-reference the diagnosis against AAPC code guidance before submission.
• No prior authorization on file: A commercial payer required prior authorization (PA), and it was not obtained. Fix: build a PA verification step into the surgical scheduling workflow for all commercial insurance patients.
• NCCI unbundling conflict: Colporrhaphy or cystoscopy billed same-day without modifier -59 when required. Fix: pre-submission claim scrubbing against NCCI edit tables flags these before they generate a denial.

Strong denial management workflows treat each denial as a data point. Log the denial codes on every 58260 rejection, trace each one to a root cause, and update the billing workflow so it does not repeat. A single correction to an operative template or charge capture form can remove a whole category of future denials.

How Pabau supports vaginal hysterectomy billing and coding

Clean 58260 billing depends on three steps lining up for every case: the right code, a complete operative record, and a validated claim. Pabau, the practice management platform we build, connects those steps through its denial-reducing claims management. The record and the claim then come from the same system.

• Claim validation before submission: Pabau scrubs every claim for missing or invalid details. A rejected claim is flagged as needing action, with a link to the field that needs correcting.
• Custom operative forms: a procedure form can make surgical approach, specimen weight, and adnexal status required fields before the note is signed.
• Eligibility checks before surgery: Pabau runs insurance eligibility verification through Claim.MD before the visit, so coverage problems surface before the surgery date.
• Records in one place: operative notes, pathology results, and diagnosis codes sit together in the patient record, ready if a payer requests documentation.

Payments post from electronic remittance advice files, so the practice can compare each 58260 payment with the expected fee schedule amount. Submitting a clean claim at first pass shortens days in accounts receivable and cuts rework.

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Pabau validates every hysterectomy claim for missing or invalid details before it reaches the clearinghouse. Your practice spends less time on denials and resubmissions.

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Conclusion

CPT 58260 rewards practices that settle the code before the patient leaves the operating room. Approach, specimen weight, and adnexal status all belong in the note, and each one changes the code when it differs.

The trade-off is a little more structure in the operative form against far fewer records requests, recoupments, and resubmissions. Make those three fields mandatory, and 58260 becomes a routine claim rather than a recurring query.

Book a demo to see how Pabau validates OB/GYN surgical claims before they reach the payer.

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