CPT code 58291: Vaginal hysterectomy, complex, with tube or ovary removal2026 Medicare rate & RVUs in California
Reports a complicated vaginal hysterectomy for a uterus over 250 grams when one or both fallopian tubes or ovaries are also removed.
CMS doesn’t publish an office rate for 58291 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 58291 covers
This code describes a complicated hysterectomy performed through the vagina for a uterus weighing more than 250 grams, with removal of one or both fallopian tubes and/or ovaries during the same operation. A gynecologic surgeon typically performs it in a hospital operating room. The operative report should establish the vaginal approach, the circumstances supporting the complicated service, the adnexal tissue removed, and uterine size or specimen weight.
Report this code rather than the corresponding vaginal hysterectomy code without adnexal removal when tube or ovary removal is part of the operation. The removal is included in this service; do not separately report it as though it were a distinct operation. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care for 90 days. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be available, and co-surgeons are permitted; team surgery is not. Modifier 50 is inappropriate.
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 58291 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $1,080.78 |
| Chico, CA | Unavailable | $1,070.15 |
| El Centro, CA | Unavailable | $1,070.78 |
| Fresno, CA | Unavailable | $1,070.15 |
| Hanford, CA | Unavailable | $1,070.15 |
| Los Angeles, CA | Unavailable | $1,125.11 |
| Madera, CA | Unavailable | $1,070.15 |
| Marin County, CA | Unavailable | $1,194.42 |
| Merced, CA | Unavailable | $1,070.15 |
| Modesto, CA | Unavailable | $1,070.15 |
| Napa, CA | Unavailable | $1,154.77 |
| Oxnard, CA | Unavailable | $1,110.35 |
| Redding, CA | Unavailable | $1,070.15 |
| Rest of California | Unavailable | $1,070.15 |
| Riverside, CA | Unavailable | $1,110.79 |
| Sacramento, CA | Unavailable | $1,100.43 |
| Salinas, CA | Unavailable | $1,095.85 |
| San Benito County, CA | Unavailable | $1,222.84 |
| San Diego, CA | Unavailable | $1,105.07 |
| San Francisco, CA | Unavailable | $1,190.14 |
| San Luis Obispo, CA | Unavailable | $1,080.83 |
| Santa Clara County, CA | Unavailable | $1,205.33 |
| Santa Cruz, CA | Unavailable | $1,102.56 |
| Santa Maria, CA | Unavailable | $1,095.43 |
| Santa Rosa, CA | Unavailable | $1,112.25 |
| Stockton, CA | Unavailable | $1,070.15 |
| Vallejo, CA | Unavailable | $1,148.60 |
| Visalia, CA | Unavailable | $1,070.15 |
| Yuba City, CA | Unavailable | $1,070.15 |
How the 58291 rate is calculated
Each of 58291’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 · 58291
RVUs × geographic indexes × conversion factor
Work21.51
21.51 RVUs× 1.000 GPCI
Practice expense7.43
7.43 RVUs× 1.000 GPCI
Malpractice3.77
3.77 RVUs× 1.000 GPCI
Adjusted RVUs
32.7100
Conversion factor
$33.4009
Medicare rate
$1,092.54
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 58291
58291 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 58291
Vaginal hysterectomy, complex, with tube or ovary removal
| 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) | 2 | Permitted. |
| 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 · 58291
Vaginal hysterectomy, complex, with tube or ovary removal
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
58291 without 51 · national facility
$1,092.54
Vaginal hysterectomy, complex, with tube or ovary removal
58291-51 · Second procedure: 50%
$546.27
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%).
58291 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 58290Vaginal hysterectomyUterus over 250 grams
- Both are complicated vaginal hysterectomy services for a uterus over 250 grams. Choose 58291 when tube and/or ovary removal is part of the operation; choose 58290 without that removal.
- 58262Vaginal hysterectomyUterus 250 g or less, with adnexa
- This code includes tube and/or ovary removal but applies to the smaller-uterus category. 58291 is for the complicated service involving a uterus over 250 grams.
- 58292Vaginal hysterectomyLarge uterus, adnexal removal, enterocele repair
- 58292 is the related complicated vaginal hysterectomy service that includes enterocele repair. Use 58291 when adnexal removal is included and the additional repair is not the distinguishing service.
- 58260Vaginal hysterectomyUterus 250 grams or less
- 58260 is the vaginal hysterectomy service without adnexal removal for the smaller-uterus category. 58291 includes adnexal removal and represents the complicated, over-250-gram service.
58291 billing questions
How does this differ from 58290?
Both describe a complicated vaginal hysterectomy for a uterus over 250 grams. Use 58291 when one or both tubes and/or ovaries are also removed; 58290 is the counterpart without that removal.
Can tube or ovary removal be billed separately?
Removal of one or both fallopian tubes and/or ovaries is included in 58291 when performed as part of the hysterectomy. The code already accounts for that work.
What documentation supports the complicated service?
The operative report should describe the vaginal approach, why the operation was complicated, which adnexal structures were removed, and the uterine size or specimen weight supporting the over-250-gram category.
What is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.
Can an assistant or co-surgeon be reported?
CMS permits assistant-at-surgery payment and co-surgeons for this code. Team surgery is not permitted.
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
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 58291 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist