| Code | Description | States | Median rate |
|---|---|---|---|
| 58100 | Endometrial (uterine lining) biopsy | 48 | $80.80 |
| 58110 | Endometrial biopsy at time of colposcopy (add-on) | 47 | $41.34 |
| 58120 | Dilation and curettage (D&C), non-pregnancy | 48 | $237.28 |
| 58140 | Fibroid removal, abdominal, 1 to 4 fibroids | 46 | $708.68 |
| 58146 | Fibroid removal, abdominal, 5 or more or over 250 g | 46 | $895.10 |
| 58150 | Total abdominal hysterectomy | 46 | $791.90 |
| 58180 | Abdominal hysterectomy leaving the cervix | 45 | $764.40 |
| 58210 | Radical abdominal hysterectomy with pelvic lymph nodes | 46 | $1,459.27 |
| 58240 | Pelvic organ removal for gyn cancer (exenteration) | 46 | $2,176.55 |
| 58260 | Vaginal hysterectomy, uterus 250 g or less | 48 | $672.67 |
| 58262 | Vaginal hysterectomy with tubes or ovaries, 250 g or less | 48 | $730.92 |
| 58267 | Vaginal hysterectomy with bladder neck suspension | 46 | $821.02 |
| 58270 | Vaginal hysterectomy with enterocele repair, 250 g or less | 48 | $729.37 |
| 58285 | Radical vaginal hysterectomy (Schauta) | 46 | $1,073.93 |
| 58290 | Vaginal hysterectomy, uterus over 250 g | 48 | $939.94 |
| 58291 | Vaginal hysterectomy with tubes or ovaries, over 250 g | 48 | $1,017.47 |
| 58294 | Vaginal hysterectomy with enterocele repair, over 250 g | 48 | $954.87 |
| 58300 | IUD insertion | 47 | $82.09 |
| 58301 | IUD removal | 48 | $85.60 |
| 58340 | Saline or dye infusion for uterus ultrasound or X-ray | 45 | $176.97 |
| 58345 | Fallopian tube catheterization through the cervix | 22 | $225.21 |
| 58350 | Dye flush of the fallopian tubes | 27 | $112.02 |
| 58353 | Endometrial ablation, thermal | 47 | $750.87 |
| 58356 | Freezing of the uterine lining with ultrasound guidance | 47 | $1,310.20 |
| 58400 | Uterine suspension | 44 | $365.72 |
| 58520 | Repair of a ruptured uterus, not pregnant | 46 | $597.68 |
| 58541 | Laparoscopic cervix-sparing hysterectomy, 250 g or less | 48 | $626.74 |
| 58543 | Laparoscopic cervix-sparing hysterectomy, over 250 g | 47 | $719.69 |
| 58545 | Laparoscopic fibroid removal, 1 to 4 fibroids | 48 | $737.85 |
| 58546 | Laparoscopic fibroid removal, 5 or more or over 250 g | 48 | $911.86 |
| 58548 | Laparoscopic radical hysterectomy with lymph nodes | 46 | $1,425.55 |
| 58550 | Laparoscopic-assisted vaginal hysterectomy, 250 g or less | 48 | $740.78 |
| 58553 | Laparoscopic-assisted vaginal hysterectomy, over 250 g | 48 | $898.83 |
| 58555 | Hysteroscopy (uterus scope), diagnostic | 48 | $242.57 |
| 58558 | Hysteroscopy with biopsy or polyp removal | 48 | $847.77 |
| 58559 | Hysteroscopy with release of uterine adhesions | 47 | $257.81 |
| 58560 | Hysteroscopy with division of a uterine septum | 46 | $279.10 |
| 58561 | Hysteroscopy with removal of a fibroid | 48 | $352.08 |
| 58562 | Hysteroscopy with removal of embedded IUD | 48 | $320.71 |
| 58563 | Hysteroscopy with endometrial ablation | 48 | $1,573.95 |
| 58565 | Hysteroscopic sterilization by tubal implants | 38 | $1,325.08 |
| 58570 | Total laparoscopic hysterectomy, 250 g or less | 48 | $676.74 |
| 58571 | Laparoscopic removal of the uterus with tubes/ovaries, 250g or less | 48 | $742.07 |
| 58572 | Total laparoscopic hysterectomy, over 250 g | 48 | $840.03 |
| 58578 | Unlisted laparoscopic uterus procedure | 13 | $2,075.40 |
| 58579 | Unlisted hysteroscopy procedure | 10 | $285.38 |
| 58580 | Radiofrequency fibroid ablation through the cervix | 40 | $2,252.13 |
| 58600 | Tubal ligation, open | 48 | $310.61 |
| 58605 | Tubal ligation after delivery, same hospital stay | 46 | $266.22 |
| 58611 | Tubal ligation during cesarean or abdominal surgery | 45 | $57.43 |
| 58615 | Tubal blocking with a clip or ring | 48 | $213.54 |
| 58660 | Laparoscopic release of tube or ovary adhesions | 48 | $556.31 |
| 58661 | Laparoscopic removal of ovary and/or tube | 48 | $512.04 |
| 58662 | Laparoscopic destruction or removal of pelvic lesions | 48 | $574.74 |
| 58670 | Laparoscopic tubal cautery sterilization | 48 | $319.05 |
| 58671 | Laparoscopic tubal occlusion with band or clip | 48 | $319.07 |
| 58672 | Laparoscopic fallopian tube end repair (fimbrioplasty) | 30 | $623.03 |
| 58673 | Laparoscopic fallopian tube opening (salpingostomy) | 40 | $617.25 |
| 58674 | Laparoscopic radiofrequency ablation of fibroids | 46 | $652.21 |
| 58679 | Unlisted laparoscopic tube or ovary procedure | 12 | $2,565.07 |
| 58700 | Removal of a fallopian tube | 46 | $597.81 |
| 58720 | Removal of tube and ovary, open | 46 | $602.64 |
| 58740 | Release of tube or ovary adhesions, open | 44 | $672.91 |
| 58750 | Fallopian tube reconnection (tubal reversal) | 13 | $707.55 |
| 58752 | Fallopian tube implantation into the uterus | 16 | $675.98 |
| 58760 | Fallopian tube end repair (fimbrioplasty), open | 19 | $627.10 |
| 58770 | Fallopian tube opening (salpingostomy), open | 36 | $659.38 |
| 58805 | Ovarian cyst drainage, abdominal approach | 48 | $346.45 |
| 58820 | Ovarian abscess drainage through the vagina | 48 | $248.67 |
| 58822 | Ovarian abscess drainage, abdominal approach | 46 | $531.34 |
| 58825 | Moving the ovaries out of a radiation field | 44 | $528.28 |
| 58940 | Ovary removal, open | 46 | $423.00 |
| 58999 | Unlisted female genital procedure (non-obstetric) | 14 | $167.89 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.