CPT code 58542 – Laparoscopic supracervical hysterectomy, up to 250g

Key Takeaways

CPT 58542 covers laparoscopic supracervical hysterectomy with uterine weight at or below 250g; the cervix is preserved, not removed

Uterine weight documented in the operative report determines whether 58542 or 58571 applies; missing weight is the top denial trigger

A 90-day global surgical period applies; modifiers 24, 78, and 79 unlock separate billing within that window

Pabau’s claims management software supports gynecologic billing workflows, including surgical code submission and denial tracking

CPT code 58542: Official descriptor and procedure overview

CPT code 58542 describes a laparoscopic supracervical hysterectomy performed on a uterus weighing 250 grams or less. According to the American Medical Association’s CPT code set, the official descriptor reads: “Laparoscopic, surgical, supracervical hysterectomy, for uteri 250 g or less.” The defining anatomical feature is cervical preservation: The uterine corpus is excised laparoscopically while the cervix and parametrial tissue remain intact.

This contrasts sharply with total laparoscopic hysterectomy codes, which include colpotomy and cervical removal. Coders who confuse the two code families produce systemic underpayments or payer audits. The table below places 58542 within its full code family.

Key distinction: 58542 specifically includes removal of one or both adnexa (ovaries and/or fallopian tubes) as part of the same laparoscopic session, which is what separates it from 58541. If neither adnexa is removed, 58541 is correct.

Procedure requirements and clinical documentation for CPT 58542

The operative report must support three specific elements for CPT code 58542 to survive payer review: The laparoscopic approach, the specimen weight at or below 250 grams, and explicit documentation that the cervix was preserved.

• Approach confirmation: The operative note must state that the procedure was completed laparoscopically. Conversion to open surgery mid-procedure changes the code to an open hysterectomy code.
• Uterine specimen weight: The pathology report or surgeon’s intraoperative note must record the actual weight in grams. “Approximately 200 grams” is sufficient; a completely absent weight measurement is not. Payers use this figure to validate that 58542 rather than 58543 or 58544 was the correct selection.
• Cervical status: The operative note must explicitly state the cervix was left in situ. Phrases such as “supracervical technique” or “cervical stump preserved” satisfy this requirement.
• Adnexal removal: Because 58542 includes adnexa, the report must identify which adnexa were removed (unilateral or bilateral ovaries, fallopian tubes, or both).
• Morcellation or intact extraction: If uterine morcellation was used, the operative report should document patient selection criteria consistent with the FDA’s 2014/2020 safety communication, which restricts power morcellation in patients with suspected uterine malignancy or certain fibroids. This documentation protects against retrospective audit liability, independent of the CPT coding question.

Absent any of these elements, the claim is vulnerable to downcoding, audit request, or outright denial. A biller who receives an operative report lacking specimen weight should contact the surgeon’s office for an addendum before submitting the claim.

CPT 58542 vs 58571 and related laparoscopic hysterectomy codes

CPT 58542 and CPT 58571 are the two most commonly confused codes in the laparoscopic hysterectomy family. The split is determined by two variables: Whether the cervix is removed, and whether the uterine weight is at or below 250 grams.

58542 is supracervical (cervix preserved) and at or below 250g. 58571 is total (cervix removed) and at or below 250g. A surgeon who removes the cervix is not performing a supracervical procedure regardless of what the operative note heading says. Coding from the procedure description rather than the code number is the correct approach.

The weight threshold creates a second axis of error. When a surgeon codes 58542 but the pathology report later returns a specimen weight of 268 grams, the claim was miscoded. Some practices correct proactively after pathology confirmation; others wait for a payer audit. The proactive approach avoids overpayment recoupment demands.

Commonly billed add-on and companion codes with CPT 58542

Certain procedures performed during the same operative session as CPT code 58542 may be separately reported, subject to National Correct Coding Initiative (NCCI) edit restrictions. Verify bundling status against the current CCI table, as edits update quarterly.

CPT 58661 (laparoscopic oophorectomy) is commonly billed alongside 58542 when oophorectomy is performed as a separately identifiable service. However, because 58542 itself includes adnexal removal, practices must document that the adnexal work represented a distinct, additional procedure beyond what is inherent to 58542. Incorrect unbundling of services already encompassed within 58542 is a recurring NCCI edit trigger. Review superbill documentation requirements for surgical encounters to ensure each line-item code has independent operative support.

Appropriate ICD-10-CM diagnosis codes for CPT 58542

Payers require a supported diagnosis to establish medical necessity for laparoscopic supracervical hysterectomy. The ICD-10-CM codes below represent the most frequently documented diagnoses for this procedure. Code validity should be confirmed against the current FY code year, as ICD-10-CM codes retire annually.

Commercial payers often maintain local coverage policies requiring documented failure of conservative management (hormonal therapy, endometrial ablation) before authorizing elective hysterectomy. Include these treatment history elements in the prior authorization package and ensure the diagnosis code selected is the highest specificity available from clinical documentation.

Modifiers for CPT code 58542

Modifier selection for CPT code 58542 depends on the clinical circumstances: Whether the procedure involved significantly increased complexity, occurred alongside another procedure, or took place within an existing global period.

Modifier 22 is the most litigated modifier in surgical billing. Payers routinely request operative reports when modifier 22 is applied, and many auto-deny claims where the documentation does not quantify the additional work in specific terms. Stating “difficult case” is not sufficient; the note should describe the adhesion extent, the additional operative time required, and the anatomical challenge encountered.

Medicare reimbursement rates and RVUs for CPT 58542

Medicare reimburses CPT code 58542 through the Medicare Physician Fee Schedule (MPFS), with rates varying by geographic locality and by whether the service is furnished in a facility or non-facility setting. The CMS MPFS search tool provides the current year’s national unadjusted rates by code and geographic practice cost index (GPCI) modifier.

For the most current RVU values, consult the FastRVU 2026 RVU lookup tool, which draws from the annual MPFS final rule. Typical components for major laparoscopic hysterectomy codes in the 585xx range include a high work RVU (reflecting substantial surgeon time and skill), moderate practice expense RVU, and a lower malpractice RVU. The MPFS conversion factor applied to total RVUs produces the national unadjusted payment amount before locality adjustment.

Facility rates are lower than non-facility rates because the facility absorbs practice expense overhead. Gynecologic surgical procedures coded as 58542 are almost exclusively performed in a hospital or ambulatory surgery center (facility) setting, so billers should use the facility rate for fee schedule comparison. Pabau’s clearinghouse integration for claim submission routes 58542 claims through Claim.MD to over 4,000 US payers, supporting CMS-1500 and 837P electronic submission with real-time eligibility checks before the claim leaves the practice.

Rate reminder: Medicare MPFS rates change annually via the final rule published each November. Always reference the effective-year CMS file rather than third-party articles, including this one, for actual dollar amounts used in contract negotiations or patient cost estimates.

Prior authorization requirements for CPT 58542

Prior authorization requirements for elective laparoscopic hysterectomy vary by payer type and individual plan, and no universal standard applies across all payers. Confirm requirements through insurance eligibility verification before scheduling the procedure.

• Traditional Medicare (Parts A and B): Generally does not require prior authorization for CPT 58542, though Medicare Advantage plans administered by private insurers frequently do. Verify plan-specifically.
• Medicare Advantage: Most Medicare Advantage plans require prior authorization for elective hysterectomy. PA denial rates for this procedure are higher than for many other surgical codes because payers evaluate whether conservative management options were exhausted.
• Commercial insurance: Most commercial plans require PA for elective hysterectomy. Required documentation typically includes clinical notes demonstrating symptom duration, failed conservative treatment (minimum 3-6 months of hormonal management or other non-surgical treatment, depending on plan policy), imaging reports, and the planned surgical approach.
• Medicaid: Requirements are state-administered and vary widely. Some state Medicaid programs require PA and may also impose additional consent requirements for hysterectomy under federal Medicaid sterilization regulations (42 CFR Part 441, Subpart F) when the procedure results in sterilization.

The clinical documentation that most reliably supports PA approval includes: The diagnosis code with specificity, prior treatment history with dates, imaging confirming the underlying pathology (ultrasound for fibroids, MRI for adenomyosis), and the physician’s narrative explaining why surgery is appropriate now. For a framework on submitting a clean claim after authorization is obtained, all authorization reference numbers should be recorded and included on the CMS-1500 form in Box 23.

Streamline gynecologic surgical billing with Pabau

Pabau supports OB/GYN practices with end-to-end claims management, from pre-authorization tracking to 837P submission through our Claim.MD clearinghouse integration. Reduce denials and accelerate reimbursement for complex surgical codes like 58542.

Book a demo

Common denial reasons and how to avoid them for CPT 58542

Denials for CPT code 58542 cluster around five root causes. Each is preventable with systematic pre-submission checks and robust claims management software that flags missing documentation before the claim leaves the practice.

• Wrong uterine weight tier: Submitting 58542 when the pathology report shows a specimen weight above 250 grams is the single most common miscoding error in this family. Implement a workflow that holds laparoscopic hysterectomy claims until the pathology report is received and the code is confirmed against the actual weight.
• Missing specimen weight in the operative report: Payers treat an absent gram weight as an unsupported claim. Request an addendum before submission rather than submitting and appealing.
• Unsupported medical necessity diagnosis: A diagnosis code that does not map to the procedure on the payer’s LCD/NCD policy, or that lacks supporting documentation in the clinical note, will trigger a medical necessity denial. D25.9 (unspecified leiomyoma) is particularly vulnerable when a more specific code (D25.1, D25.2) is supported by imaging.
• Absent or expired prior authorization: Submitting an elective procedure without a valid PA reference number is an automatic denial from most commercial payers. Track authorization expiration dates relative to surgery scheduling.
• CCI edit conflict: Billing a service that NCCI has bundled into 58542 without a supporting modifier and distinct operative documentation triggers an automated edit denial. Review current CCI tables before adding companion codes to the claim.

For denials that do reach appeal, review denial management workflows that prioritize reconsideration within the payer’s timely filing window (typically 90-180 days from the remittance date). Attach the operative report, pathology report, and a specific rebuttal letter to every clinical appeal.

Global surgical package and post-operative billing for CPT 58542

CPT code 58542 carries a 90-day global surgical period, meaning routine pre-operative services on the day before and day of surgery, all intra-operative services, and routine post-operative care through day 90 are bundled into the single surgical fee. Separate billing for office visits within this window requires a modifier that unlocks the claim from the global package.

Understanding medical billing fundamentals around global periods is essential for gynecologic practices where patients often follow up for cervical stump surveillance, pelvic floor concerns, or unrelated conditions within the same 90 days.

• Modifier 24 (unrelated E&M during global period): Applies when the patient is seen for a problem that is clearly unrelated to the hysterectomy. The visit’s diagnosis code must support the unrelated nature of the service. Example: A patient seen for an acute urinary tract infection 30 days post-op qualifies; a patient seen for pelvic discomfort does not.
• Modifier 25 (significant, separately identifiable E&M on the day of procedure): Applies when a pre-operative evaluation on the day of surgery goes beyond the routine pre-operative assessment included in the global package. This is rare for scheduled elective procedures.
• Modifier 79 (unrelated procedure in global period): If the patient requires a surgical procedure for an unrelated problem within the 90-day window, modifier 79 appended to the new procedure unlocks separate payment. The unrelated nature must be documented in the operative report.
• Modifier 78 (return to OR for related complication): Post-hysterectomy hemorrhage, wound complication, or laparoscopic port site complication requiring return to the OR is reported with modifier 78 on the new procedure code. Payment is typically a percentage of the full global fee, not the full amount, because a new global period does not restart.

Conclusion

Accurate billing for CPT code 58542 depends on three things: Confirmed uterine weight at or below 250 grams, documented cervical preservation, and an operative report detailed enough to survive payer review. Miscoding the weight tier and submitting without PA are the two fastest paths to denial for this procedure family.

Pabau’s claims management software helps gynecologic practices catch these documentation gaps before submission, with Claim.MD clearinghouse integration supporting electronic 837P claims, real-time eligibility checks, and ERA remittance tracking across major US payers. To see how Pabau handles surgical claim workflows, book a demo.

Continue your research

Need a clearinghouse for surgical claims? Claim.MD clearinghouse overview explains how Pabau’s integration routes claims to 4,000+ US payers with real-time eligibility and ERA remittance.

Want to reduce surgical billing denials? Denial codes in medical billing covers the CARC codes that appear on 58542 remittance advice and how to respond to each.

Looking for OB/GYN specific software? OB/GYN EMR and practice management outlines the clinical documentation and billing features Pabau provides for gynecologic surgical practices.

Frequently Asked Questions