CPT code 58670 – Laparoscopic fulguration of fallopian tubes

Key takeaways

CPT 58670 covers laparoscopic fulguration of both fallopian tubes, with or without transection, when the tubes are cauterized but not removed.

Code by technique: salpingectomy is 58661, tubal ligation at cesarean is 58611, and lesion fulguration for endometriosis is 58662.

Medicaid pays only if the patient, aged 21 or over, signed a CMS-116 consent form 30 to 180 days before surgery.

Age and eligibility aren’t the test for Medicare: NCD 230.3 excludes elective sterilization outright, so 58670 billed with Z30.2 is essentially never payable.

Pabau, the practice management platform we build, keeps signed consent forms on the patient record and submits claims electronically through Claim.MD.

CPT Code 58670: Definition and procedure overview

CPT Code 58670 describes laparoscopy with fulguration of oviducts (with or without transection). In this electrosurgical sterilization technique, the surgeon cauterizes both fallopian tubes and may also cut them.

The American Medical Association places it in the oviduct/ovary subsection (58600–58770) of the female genital system surgery codes, as the AAPC’s CPT code ranges show.

Fulguration uses high-frequency electrical current to destroy tissue. The surgeon applies bipolar or monopolar electrosurgery to a segment of each tube until the tissue is coagulated and blood flow stops. Mechanical occlusion with clips or rings is reported with 58671, and excision (salpingectomy) with 58661. Each technique has its own CPT code.

The procedure is nearly always performed in an outpatient hospital or ambulatory surgical center (ASC) under general or regional anesthesia. Bilateral fulguration is the standard. Unilateral fulguration is uncommon, but it happens when one tube was already removed or ligated.

The AMA’s CPT coding resources include the annual codebook update summaries, which flag descriptor changes to 58670 and its neighboring codes. Review them each January, before the new code set takes effect.

Key code facts at a glance

Procedure steps and documentation requirements

Documentation must confirm laparoscopic access, identification of both tubes, and electrosurgical fulguration of each tube. A note that says “tubal ligation” without naming the technique is insufficient and invites a coding query or audit.

The operative note should capture these elements to support CPT Code 58670 on audit:

1. Laparoscope insertion: trocar placement site, insufflation pressure, and confirmed visualization
2. Bilateral tube identification: both fallopian tubes visualized and identified in their entirety
3. Electrosurgical fulguration: the technique (bipolar or monopolar), the location on the tube (isthmic segment), the number of applications per tube, and visual confirmation of coagulation
4. Transection (if performed): whether the tubes were transected after fulguration, since the CPT descriptor makes transection optional
5. Laterality: an explicit statement that fulguration was bilateral, or the clinical reason if only one tube was treated

Practice software with custom note templates can prompt surgeons for each of these elements before the note is signed.

CPT 58670 vs 58661 vs 58611 vs 58662: Choosing the right sterilization code

These four codes are the most frequently confused in OB/GYN sterilization billing. The operative note decides which one applies: what the surgeon did to the tubes, and whether it happened during a cesarean.

Common selection error: reporting 58661 when the surgeon fulgurated the tubes without removing them. Salpingectomy requires documentation that the tube was excised and sent to pathology. Fulguration with transection stays 58670, because the segment is coagulated and severed but never removed as a specimen.

ICD-10 diagnosis codes to pair with 58670

Z30.2 (Encounter for sterilization) is the primary ICD-10-CM diagnosis code for CPT Code 58670 in elective sterilization cases. Confirm the exact code for the applicable fiscal year in the CDC ICD-10-CM web tool before submission.

Add secondary diagnoses when a co-existing condition influenced the clinical decision or was managed during the same encounter. A secondary code can’t be the only diagnosis on a 58670 claim, and Z30.2 must be listed first. Knowing the full medical billing workflow for sterilization claims helps prevent sequencing errors.

Medicare coverage and reimbursement for CPT Code 58670

Medicare excludes elective sterilization under National Coverage Determination (NCD) 230.3, whatever the beneficiary’s age. It pays for 58670 only when sterilization is a medically necessary part of treating an illness or injury, and never when the purpose is contraception. A 58670 claim paired with Z30.2 is therefore denied as a non-covered service.

In the rare covered case, the Medicare Physician Fee Schedule (MPFS) sets the professional payment. Use the CMS MPFS lookup tool to pull current facility and non-facility rates for your locality. Rates change every year, so dollar amounts published elsewhere may be out of date.

Place of service impact on Medicare rates

This rate structure only applies in the rare case Medicare covers the procedure, meaning a medically necessary, non-elective sterilization. Medicare then pays two different rates for 58670, depending on where it was performed. The facility rate (POS 22 outpatient hospital or POS 24 ASC) is lower because Medicare pays the facility separately.

The non-facility rate (POS 11 office) is higher because the practice absorbs the overhead. Sterilization in a physician’s office is unusual, but the non-facility rate applies when it happens.

Medicaid billing requirements: Consent form, waiting period, and fee schedules

Federal Medicaid sterilization requirements under 42 CFR Part 441 Subpart F are among the strictest in ambulatory billing. Missing any one of them makes the claim non-payable, and it can’t be corrected retroactively. Good medical billing compliance processes capture these requirements before the surgical date.

• CMS-116 consent form: the patient must sign a CMS-116 “Consent to Sterilization” form voluntarily, in a language they understand, with an interpreter if required. Under 42 CFR 441.253, surgery must take place at least 30 days and no more than 180 days after signing.
• 30-day waiting period: the minimum interval between the date of consent and the date of the procedure is 30 days. Premature delivery and emergency abdominal surgery are the only exceptions, covered below. Claims submitted without proof of the 30-day interval are denied.
• Patient age minimum: the patient must be at least 21 years old at the time consent is signed.
• Mental competency: the patient must not be mentally incompetent or institutionalized under involuntary commitment at the time of consent.
• Consent on file before billing: the signed CMS-116 must be in the patient record when the claim is billed, not added afterward.
• Emergency exception: in a premature delivery or emergency abdominal surgery, sterilization may go ahead once at least 72 hours have passed since consent. For a premature delivery, the consent must also have been signed at least 30 days before the expected delivery date.

Together, these rules give every consent form a fixed window, and the surgery date has to land inside it.

State Medicaid fee schedules for CPT Code 58670 vary considerably. Rates depend on each state’s conversion factor and geographic adjusters. Each state Medicaid agency publishes its own rate table, so check the current one before estimating revenue for a sterilization procedure.

Modifiers and NCCI bundling rules

Modifier selection for CPT Code 58670 depends on whether the procedure was reduced, performed alongside other services, or caught by an NCCI bundling edit. Attaching the wrong modifier, or leaving off a required one, is a fast path to denial or a post-payment audit. Effective claims management software applies modifier logic based on the procedure and setting.

NCCI bundling: CPT 58670 and CPT 49320

NCCI edits may bundle diagnostic laparoscopy, reported as 49320, into 58670 when both fall on the same date. The National Correct Coding Initiative treats diagnostic laparoscopy as part of surgical laparoscopy, because 58670 already includes laparoscopic access.

Billing both for the same encounter usually gets 49320 denied. The exception is a modifier 59 backed by documentation of a separate session or a distinct diagnostic purpose. CMS updates the edit pairs quarterly, so check the current NCCI table before submitting.

Common denial reasons and how to appeal them

Most 58670 denials fall into one of six categories. The claim adjustment reason code (CARC) on the remittance advice tells you whether to appeal, send a corrected claim, or resubmit. Our guide to denial codes explains what each one means.

Systematic denial management cuts write-offs by catching these errors while the claim is being built, before adjudication.

• Missing or expired CMS-116 consent form (Medicaid): the most common Medicaid denial. Reimbursement can’t be recovered if the form wasn’t signed before the procedure, or if surgery fell outside the 30-to-180-day window. Prevention is the only remedy.
• Wrong ICD-10 pairing: reporting a secondary code as the only diagnosis, or omitting Z30.2, results in a medical necessity denial. Resubmit with corrected sequencing.
• Non-covered service (Medicare): NCD 230.3 excludes elective sterilization outright, so 58670 billed with Z30.2 is denied whatever the patient’s age. Appeal only when the record shows sterilization was a necessary part of treating an illness or injury. For elective cases, issue an Advance Beneficiary Notice (ABN) before surgery so the patient knows Medicare won’t pay.
• NCCI bundling conflict with 49320: denied as included in 58670. Appeal with documentation supporting a distinct diagnostic purpose, and apply modifier 59 if supported.
• Timely filing exceeded: commercial payers usually allow 90 to 365 days from the date of service, and Medicare allows 12 months. Track submission dates against each payer’s filing window.
• Incorrect place of service: the POS on the claim doesn’t match where the procedure took place. Correct the POS code and resubmit.

Submitting a clean claim the first time is still the most cost-effective way to prevent denials. Verify insurance eligibility, confirm the consent form is complete, and run the claim through an NCCI scrubber before the date of service.

How Pabau keeps 58670 claims consent-ready from booking to payment

Sterilization denials usually start well before the claim. The CMS-116 sits in a paper chart, nobody checks the surgery date against the consent window, and the biller finds out at remittance.

Pabau’s claims and billing software keeps the signed consent form on the patient record as a digital form, next to the appointment for the procedure. Your team can see the signing date and the surgery date side by side before the patient is booked in.

When the claim is ready, Pabau sends it electronically through Claim.MD, its US clearinghouse connection. Your billers can run eligibility checks before surgery, follow each claim’s status, and post the electronic remittance when it arrives. The result is fewer non-payable Medicaid claims and less time chasing paperwork after the date of service.

Streamline OB/GYN sterilization billing from consent to claim

Pabau keeps signed consent forms on the patient record and submits claims electronically through Claim.MD. Your 58670 claims go out with the paperwork payers check.

Book a demo

Conclusion

Two checks decide whether a 58670 claim pays. Before you code, confirm from the operative note that the tubes were fulgurated and not excised. Before you schedule, confirm the payer will cover the procedure at all.

For a Medicaid patient, that means a CMS-116 signed 30 to 180 days before surgery. For a Medicare patient, it means telling them while the surgery is still being planned that elective sterilization isn’t covered.

An appeal can’t repair either one, so the work belongs at scheduling. Book a demo to see how Pabau keeps consent forms and claims on one patient record for OB/GYN practices.

Continue your research

Need to understand how clearinghouse claims submission works? Medical claims clearinghouse guide explains how electronic claim routing reduces rejection rates and speeds payment for surgical procedures.

Dealing with repeated 837 file errors on OB/GYN claims? 837 file billing guide walks through the transaction set structure and the most common format errors that cause claim rejections.

Building superbills for surgical cases? Superbill guide covers how to structure superbills for surgical cases, including diagnosis sequencing and modifier fields.

Performing the sterilization during a cesarean? CPT code 58611 covers tubal ligation or transection at the time of cesarean delivery.

Treating endometriosis during the same laparoscopy? CPT code 58662 explains how to code fulguration or excision of pelvic lesions.

Frequently asked questions