No office rate
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.
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CMS RVU26D · Effective 2026-10-01
58291 Vaginal hysterectomy Medicare reimbursement rates in Texas
Reports a complicated vaginal hysterectomy for a uterus over 250 grams when one or both fallopian tubes or ovaries are also removed. Compare 58291 office and facility rates across CMS payment localities in Texas.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 58291 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 58291 pays more and less in Texas
Gynecologic surgery
About 58291: Complicated vaginal hysterectomy with adnexal removal
Reports a complicated vaginal hysterectomy for a uterus over 250 grams when one or both fallopian tubes or ovaries are also removed.
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.
CMS billing rules for 58291
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU21.51 · 66%
- Practice expense (office) RVU7.43 · 23%
- Malpractice RVU3.77 · 12%
34
Medicare services in 2024 · #5589 by national volume
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.
58291 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
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.
No office rate
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.
No office rate
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.
Compare 58291 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $1094.02 |
| Beaumont | Office Unavailable | Facility $1061.27 |
| Brazoria | Office Unavailable | Facility $1068.35 |
| Dallas | Office Unavailable | Facility $1080.14 |
| Fort Worth | Office Unavailable | Facility $1079.29 |
| Galveston | Office Unavailable | Facility $1074.90 |
| Houston | Office Unavailable | Facility $1143.90 |
| Rest Of Texas | Office Unavailable | Facility $1067.67 |
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,53458280,,Hysterectomy/revise vagina,A,,17.87,6.92,NA,6.92,,3.13,27.92,27.92,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,53558285,,Extensive hysterectomy,A,,22.80,11.71,NA,11.71,,5.27,39.78,39.78,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,53658290,,Vag hyst complex,A,,19.76,7.06,NA,7.06,,3.46,30.28,30.28,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,53758291,,Vag hyst incl t/o complex,A,,21.51,7.43,NA,7.43,,3.77,32.71,32.71,0,090,0.12,0.74,0.14,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,53858292,,Vag hyst t/o & repair compl,A,,22.77,7.69,NA,7.69,,3.99,34.45,34.45,0,090,0.12,0.74,0.14,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,53958294,,Vag hyst w/enterocele compl,A,,21.01,7.33,NA,7.33,,3.68,32.02,32.02,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,54058300,,Insert intrauterine device,N,+,0.98,2.07,,0.22,,0.11,3.16,1.31,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00