CPT code 58611 – Tubal ligation at cesarean section

Key takeaways

CPT 58611 is an add-on code for tubal ligation at cesarean delivery or intra-abdominal surgery. It always rides on a primary code such as 59510.

Modifier -80 covers an assistant surgeon and -62 covers co-surgeons, while -51 never belongs on an add-on code.

Medicare does not cover elective sterilization under NCD 230.3, so 58611 is payable only when a non-sterilization diagnosis makes the procedure medically necessary.

Medicaid requires the federal sterilization consent at least 30 days before surgery, dropping to 72 hours for premature delivery or emergency abdominal surgery.

Medicare pays about $65 for 58611 in 2026, based on 1.95 total RVUs and a work RVU of 1.41.

What CPT code 58611 covers, and why the plus sign matters

CPT code 58611 reports ligation or transection of the oviducts during a cesarean delivery or another open intra-abdominal operation. The American Medical Association files it under Incision Procedures on the Oviduct/Ovary, the 58600 to 58615 range.

The plus sign in front of the code is the part that decides how it gets billed. An add-on code never stands alone on a claim. It has to appear next to the primary code for the surgery during which the ligation happened.

That single rule explains most 58611 rejections. The rest come down to consent paperwork, and the table below is the short version of both.

When to report 58611, and when another code fits better

Report 58611 when the tubal ligation happens in the same operative session as a cesarean section or another open abdominal case. It does not apply to a standalone sterilization, and it does not apply to a laparoscopic approach. Both of those have their own codes.

Three situations account for nearly every legitimate 58611 claim.

• Planned postpartum sterilization at a scheduled cesarean delivery.
• Sterilization at an unplanned cesarean, where a valid consent form is already on file.
• Ligation during other open abdominal surgery, such as a myomectomy, which then supplies the primary code.

Worked through as claims, the split looks like this.

• Billable as 58611: scheduled cesarean delivery with bilateral tubal ligation at the same sitting. Report 59510 and 58611.
• Billable as 58611: cesarean delivery only, with oviduct transection during the same case. Report 59514 and 58611.
• Not 58611: laparoscopic sterilization done as its own procedure. Report 58670 for fulguration, or 58671 when a device occludes the tubes.
• Not 58611: postpartum ligation after a vaginal delivery, during the same hospitalization. Report 58605.
• Not 58611: laparoscopic removal of the tube or ovary. Report 58661.

Which primary code 58611 rides along with

The primary code is almost always a cesarean delivery code, and it belongs on the same claim. Submit 58611 by itself and the payer rejects it as an unbundled add-on, without ever reading the notes.

How a 58611 claim moves from the OR to the payer

The operative report is where a 58611 claim is won or lost. Your coder reads it, pulls the primary cesarean code, then adds 58611 underneath. The scrubber checks the pairing, the clearinghouse forwards it, and the payer adjudicates both lines together.

If the primary line is missing or wrong, 58611 drops out before a human ever sees it. The pairing works only when the delivery code itself is right, so check how 59510 is built before you lean on it.

The two modifiers that apply, and the one that never does

Modifier -51 never goes on 58611. Add-on codes are exempt from it by definition, and appending it invites a payment reduction. That leaves -80 and -62, and each one answers a different question about who did the work.

How 58611 differs from the laparoscopic sterilization codes

Approach decides the code. 58611 is open surgery through an abdominal incision, so a laparoscopic sterilization belongs somewhere else entirely. The three codes that get confused with it are 58670, 58671 and 58661.

58661 causes the most trouble of the four, because it removes tissue rather than interrupting it. Sterilization is often the reason for a laparoscopic salpingectomy, but the code still describes a removal. If the operative note says the tubes were tied or divided laparoscopically, the answer is 58670 or 58671.

The AAPC CPT code lookup carries the current descriptors if you want to check one at the desk.

What Medicare, Medicaid and commercial payers cover

Medicare does not pay for elective sterilization. NCD 230.3 excludes it, so 58611 is covered only when a non-sterilization diagnosis makes the procedure medically necessary.

That matters less often than it sounds, since few Medicare beneficiaries are having cesarean deliveries. It matters a great deal for dual-eligible patients, where the Medicaid side carries the coverage and the paperwork.

• Medicare: elective sterilization is excluded under NCD 230.3. Coverage needs a separate medical indication documented in the record.
• Medicaid: covered, subject to the federal consent rules in 42 CFR Part 441, Subpart F. States layer their own forms and timelines on top.
• Commercial payers: most plans cover tubal ligation at cesarean section. Prior authorization and consent rules vary by carrier, so verify before scheduling.
• Non-covered: consent signed outside the legal window, a missing operative note, or a sterilization Medicare treats as elective.

Consent timing decides whether the claim gets paid

The sterilization consent rule is a Medicaid rule, not a Medicare one. It lives in 42 CFR 441.258, and it has exceptions that a lot of billing teams never get told about.

The standard window is 30 days between the patient’s signature and the procedure. Sign it 29 days out and the claim is not payable, whatever the chart says. Two situations shorten that window, and one outer limit closes it.

A premature delivery drops the requirement to 72 hours, provided the form was signed at least 30 days before the estimated delivery date. Emergency abdominal surgery drops it to 72 hours as well. Only those two situations shorten the window, so a rescheduled elective cesarean does not qualify.

The form carries conditions beyond the calendar. The patient must be at least 21 years old at signing, mentally competent, and not institutionalized. It also has to be in her own language, or come with an interpreter’s certification.

What 58611 pays in 2026

Medicare’s 2026 national payment for 58611 is roughly $65. That comes from 1.95 total RVUs, of which 1.41 is work RVU.

The figure is low because the add-on only pays for the extra effort of the ligation. The cesarean delivery itself is already being paid on the primary line. Geographic practice cost index adjustments then move the number by locality.

For your own area, run the code through the CMS physician fee schedule lookup. Commercial rates usually land between 110% and 150% of the Medicare amount, depending on your contract. Your remittance data is the only place to confirm what you are being paid.

Documentation that stands up to a payer audit

A 58611 claim rests on four pieces of documentation, and an audit will ask for all of them. Missing one is usually fatal, because the fix has to exist before the surgery, not after the denial.

• Operative note: it must describe the ligation or transection as its own step inside the cesarean report. Name the technique used, and say whether the procedure was bilateral.
• Sterilization consent form: the signed federal form belongs in the record, dated inside the window the payer applies. Keep the interpreter certification with it where one was used.
• Medical necessity: for Medicaid and commercial plans the encounter diagnosis usually covers this. For Medicare, the record has to show a separate clinical indication.
• Primary procedure: the cesarean delivery needs its own complete documentation, because 58611 cannot exist on a claim without it.

Before you submit: A five-point check

Run this before the claim leaves your practice. It takes under a minute, and it catches the denials that cannot be appealed later.

• The primary cesarean code sits on the same claim as 58611.
• The consent signature date clears the window that payer applies.
• The operative note names the ligation as a separate step.
• Z30.2 or another supporting diagnosis is attached.
• No modifier -51 appears anywhere on the 58611 line.

Which ICD-10 codes belong on the claim

Every 58611 claim needs at least one ICD-10-CM code explaining why the sterilization happened. Z30.2 does that job on most of them. The rest depends on why the cesarean was performed, and those codes come out of the delivery record.

ICD-10-CM updates every October 1, so check that Z30.2 and its companions are still active before you bill.

Where 58611 claims go wrong

58611 denials repeat. The same six problems produce most of them, and each one gets caught before submission rather than on appeal. Reading the remittance advice tells you which one you hit, since medical billing denial codes map every rejection to a cause.

• No primary code: 58611 arrives alone, and the payer rejects it as an unbundled add-on.
• Consent outside the window: under Medicaid rules the signature came too late, and no clinical argument repairs it afterwards.
• Modifier -51 appended: add-on codes are exempt, so the modifier triggers a reduction or a rejection.
• Thin operative note: the ligation is mentioned but never described as its own step. Payers audit these notes.
• Wrong code for the approach: the case was laparoscopic, so 58670, 58671 or 58661 applied instead.
• Diagnosis mismatch: the claim carries no code explaining the sterilization. Attach Z30.2 or an obstetric code that does.

How Pabau keeps 58611 claims clean for OB-GYN teams

Sterilization consent usually lives on paper, or in a shared spreadsheet somebody updates by hand. The form gets signed at a prenatal visit, then sits in a folder until somebody goes looking for it at claim time. By then the delivery date has moved twice.

Pabau puts that form on the patient record instead. Patients complete the sterilization consent digitally, and the signature is date-stamped the moment they submit it. Your billing team can then check the window without hunting through a folder.

Charting, coding and submission all happen in the same system, which keeps the operative note and the claim from drifting apart. Billing runs from that record through our claims software for OB-GYN practices, which submits both lines and tracks what comes back.

The outcome is fewer consent-timing denials, and less time spent rebuilding claims that were never appealable in the first place.

Keep sterilization consent and claims in one system

Pabau tracks sterilization consent dates, stores the operative documentation, and submits clean claims for procedures like CPT 58611. Book a demo to see the workflow end to end.

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Conclusion

58611 is not a complicated code, but it is an unforgiving one. The pairing and the consent date have to be right before the claim goes out, because neither can be argued back afterwards.

Build both checks into the pre-submission step rather than the appeals queue. Practices that do this stop seeing the same denial reason every quarter. Their OB-GYN revenue also stops depending on who remembered to file a form.

Getting the dates and the documentation into one place is most of the work. Book a demo to see how Pabau handles sterilization consent and claim submission for OB-GYN practices.

Continue your research

Need the full picture of how an OB-GYN claim gets paid? What medical billing involves walks through the process from the encounter to the remittance.

Seeing the same denial reason every quarter? Denial management in healthcare sets out how to build an appeals process that closes the loop.

Coding the delivery as well as the ligation? ICD-10 code O82 explains the cesarean delivery encounter code and when it belongs on the claim.

Want fewer rejections before they ever reach the payer? What a clean claim contains covers the checks that get a claim paid on first pass.

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