CPT code 58146: Myomectomy, complex abdominal approach2026 Medicare rate & RVUs in Texas
Reports abdominal removal of a substantial fibroid burden when the surgeon preserves the uterus and the documented count or weight meets the complex level.
CMS doesn’t publish an office rate for 58146 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 58146 covers
A gynecologic surgeon removes uterine fibroids through an abdominal approach while preserving the uterus. This level is for cases meeting the high-burden threshold by fibroid count or total specimen weight: five or more intramural fibroids, or a total weight over 250 grams. The procedure is generally performed in a hospital or other surgical facility for patients seeking fibroid treatment without hysterectomy.
Select the level from the operative record, including the number of intramural fibroids removed and, when relevant, the total specimen weight. The record should establish the abdominal approach and the uterine-sparing procedure. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 58146 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $1,016.55 |
| Beaumont, TX | Unavailable | $985.21 |
| Brazoria, TX | Unavailable | $992.39 |
| Dallas, TX | Unavailable | $1,003.28 |
| Fort Worth, TX | Unavailable | $1,002.42 |
| Galveston, TX | Unavailable | $998.43 |
| Houston, TX | Unavailable | $1,061.94 |
| Rest of Texas | Unavailable | $991.42 |
How the 58146 rate is calculated
Each of 58146’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 58146
RVUs × geographic indexes × conversion factor
Work19.83
19.83 RVUs× 1.000 GPCI
Practice expense7.08
7.08 RVUs× 1.000 GPCI
Malpractice3.47
3.47 RVUs× 1.000 GPCI
Adjusted RVUs
30.3800
Conversion factor
$33.4009
Medicare rate
$1,014.72
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 58146
58146 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 58146
Myomectomy, complex abdominal approach
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.12/0.74/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 58146
Myomectomy, complex abdominal approach
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
58146 without 51 · national facility
$1,014.72
Myomectomy, complex abdominal approach
58146-51 · Second procedure: 50%
$507.36
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
58146 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 58140MyomectomyAbdominal, limited burden
- Both describe abdominal uterine-sparing fibroid removal. Choose 58146 when the intramural fibroid count or total weight meets the complex threshold; 58140 represents the lower level.
- 58145MyomectomyVaginal approach
- This code is for the abdominal approach. Code 58145 is the vaginal-approach option, so the operative route distinguishes them.
- 58150HysterectomyAbdominal, cervix removed
- Myomectomy removes fibroids while preserving the uterus. Code 58150 is for total abdominal hysterectomy, in which the uterus is removed.
- 58180HysterectomyAbdominal, cervix retained
- This code preserves the uterus after fibroid removal. Code 58180 describes supracervical abdominal hysterectomy, which removes the uterus while retaining the cervix.
58146 billing questions
How is this level distinguished from 58140?
Use this complex level when the case meets the threshold by count or weight: five or more intramural fibroids, or total specimen weight over 250 grams. Code 58140 is the lower abdominal myomectomy level.
Does the fibroid count or total weight determine the level?
Either qualifying measure supports the complex level. Document the intramural fibroid count and specimen weight when available so the operative record supports the selected code.
Is modifier 50 appropriate for fibroids on both sides of the uterus?
No. CMS identifies bilateral adjustment as inappropriate for this code; the descriptor and anatomy do not support modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care through 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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