Laparoscopically assisted vaginal hysterectomy (LAVH) is a hysterectomy technique that involves release of upper uterine attachments laparoscopically with the vagina, utilising laparoscopy to excise the uterus and cervix.
CPT 58550 is utilized directly in reference to LAVH that is performed on a uterus that is 250 grams or less, where the tubes and ovaries are not removed. The choice of code is determined by three criteria, and this includes the attested uterine weight, the degree of laparoscopy / vaginal dissection recorded on the operative note, and the adnexal structures.
Coders also need to differentiate between 58550 and other codes associated with it 58552- 58554, as well as between 58550 and total laparoscopic hysterectomy (TLH) codes.
CPT 58550 Definition: LAVH Coding for Uterus 250g or Less
The code is limited to a particular weight threshold and a combination of a surgical approach.
CPT Code 58550 - Laparoscopy, surgical, and include vaginal hysterectomy, of uterus 250 g or less.
It is a laparoscopically-assisted vaginal hysterectomy wherein upper uterine attachments, ligaments and vascular pedicles are laparoscopically released followed by gynecocytomic excision of the uterus and cervix involving the vaginal canal, with no excision of the fallopian tubes or the ovaries.
This code falls under Laparoscopic/Hysteroscopic Procedures on the Corpus Uteri and is part of the 58550--58554 code family. Pathology report or intraoperative evaluation confirm uterine weight. The code continues to be implemented in the latest CPT and CMS reference materials up to 20252026.
When to Use CPT 58550 for LAVH Procedures
Only in case of the following criteria being met and recorded then report this code.
- Uterine weight 250 grams or less, as determined in the operative report or pathology.
- Laparoscopy involves the removal of upper uterine attachments, ligaments and vascular pedicles.
- The cervical detachment and the removal of the specimen are done using the vaginal approach.
- No ovary(s) or tube(s) are taken out in the procedure.
- The laparoscopic and the vaginal parts are recorded in the operative note separately.
When Not to Use CPT 58550 in Hysterectomy Coding
These situations demand an alternate code to the 58550 family or an alternate code set altogether.
- Uterine weight exceeds 250 grams - report CPT 58553 (or 58554 with adnexal removal) instead.
- Tube(s) or ovary(s) are removed - report CPT 58552 instead of 58550.
- The entire uterine and cervical detachment is performed laparoscopically, with the specimen removed vaginally or abdominally - report total laparoscopic hysterectomy codes 58570--58573 instead.
- The cervix is retained (supracervical hysterectomy) - report codes 58541--58544 instead.
- Diagnostic laparoscopy (49320) or pelvic exam under anesthesia (57410) - do not report separately; both are bundled into 58550.
Modifiers for CPT 58550 LAVH Claims
Apply modifiers based on documented procedural complexity and claim circumstances.
- Modifier 22 - Extensive adhesions, prior surgery, or documented increased complexity beyond the standard procedure.
- Modifier 51 - Reported when 58550 is billed with other significant, separately identifiable procedures in the same session.
- Modifier 59 / X{EPSU} - Applied when a distinct procedural service is performed that is not otherwise bundled, when supported by documentation.
- Modifier 78 - Used for an unplanned return to the operating room during the global period for a related complication.
- Modifier 79 - Used for a staged or unrelated procedure performed during the global period.
Documentation Requirements for CPT 58550 Coding Accuracy
The operative report must clearly support both components of the procedure and the weight threshold.
- Operative note specifying laparoscopic detachment of the upper uterine attachments and vascular pedicles.
- Vaginal removal of the cervix and uterus documented as a distinct operative step.
- Uterine weight of 250 grams or less confirmed by the operative report or pathology.
- Explicit confirmation that no tube or ovary was removed; if removed, code as 58552.
- No separate documentation submitted for diagnostic laparoscopy or exam under anesthesia, as both are included.
Reimbursement Guidelines for CPT 58550 Under Medicare PFS
Payment follows standard MPFS rules with specific bundling edits applicable to this code family.
- Active surgical code payable under the Medicare Physician Fee Schedule, based on facility or non-facility RVUs.
- Diagnostic laparoscopy (49320) is bundled and not separately reportable.
- Pelvic exam under anesthesia (57410) is bundled and not separately reportable.
- Subject to NCCI edits under CMS Policy Manual Chapter 7 (female genital system bundling rules).
- Payment amount varies by year, locality, and GPCI adjustment - verify current MPFS rates before billing.
- Medicare hysterectomy claims may require specific medical necessity documentation to support payment.
Common CPT 58550 Coding Scenarios in Gynecologic Practice
These scenarios illustrate correct code selection across common LAVH cases.
- Scenario 1 - Uterine weight is ascertained to be 210 grams. The surgeon laparoscopically emancipates the upper uterine attachments and the cervical detachment and removal of the adnexa is done vaginally, without any adnexa being removed. CPT 58550 is reported alone.
- Scenario 2 - A bilateral salpingo-oophorectomy is done during the same procedure. CPT 58552 is used instead of 58550 to demonstrate the adnexal removal.
- Scenario 3 - Pathology confirms that after LAVH, there was a uterine weight of 310 grams. CPT 58550 is inapplicable, the claim should be coded to 58553, or 58554 in case of adnexa removal as well.
- Scenario 4 - The surgeon does the entire uterine and cervical detachment laparoscopically and removes the specimen vaginally without morcellation. It is a complete laparoscopic hysterectomy, not LAVH - report 5857058573 as opposed to 58550.
- Scenario 5 - A diagnostic laparoscopy is done to examine the pelvis prior to LAVH during the same session. CPT 49320 is not charged independently, but included in CPT 58550.
How CureCloudMD Powers LAVH Billing With 98% Clean Claim Rate
The coding team at CureCloudMD uses specialty-specific rules on each LAVH claim, starting at a weight-threshold verification to edits of bundling.
The claims of CPT 58550 clearly need effective cross-checking of uterine weight, removal status of adnexal, and laparoscopic-versus-vaginal breakdown in the operative note. Prior to being submitted, CureCloudMD OBGYN medical billing and coding experts compare them to the current CMS and NCCI edits to avoid rework associated with a classification of controversial code family (58550 vs. 58552 vs. 58553/58554) or TLH miscoding.
CureCloudMD also tracks payer-related medical necessity conditions of claims involving hysterectomies and identifies points of gaps in documentation to promptly stop practices from stalling due to a lack of full reports about the operations.
- 98%+ Clean Claim Rate - Reported performance indicator across gynecologic surgery claims.
- 1.2% Average Denial Rate - Reflecting proactive documentation and coding review before claim submission.
- Dedicated Gynecology Coding Expertise - Coders trained specifically on LAVH, TLH, and LSH code family distinctions.
- Faster Reimbursement Turnaround - Through consistent claim accuracy and reduced rework.
The most LAVH claims tend to go astray is by getting the right code family selection, which is what CureCloudMD is instituting into each claim. Billing CPT 58550 and codes can be done using CureCloudMD to help with investment in weight documentation, bundling requirements, and code choice prior to submitting claims.
