CPT 58571 is the billing code used in the United States for a total laparoscopic hysterectomy (TLH) performed on a uterus weighing 250 grams or less, with the additional removal of one or both fallopian tubes and/or ovaries. It belongs to a family of four closely related codes (58570–58573) that together cover all laparoscopic total hysterectomies, distinguished by uterine weight and whether the tubes or ovaries come out too. If you’ve encountered this code on a surgical estimate or an insurance explanation of benefits, the rest of this article covers what the procedure actually involves, how it compares to other approaches, what recovery looks like, and the practical details patients and coders tend to ask about next.
How CPT 58571 Fits Among Related Codes
The four CPT codes for total laparoscopic hysterectomy are organized along two axes: uterine weight (250 grams or less versus more than 250 grams) and whether the surgeon also removes a tube or ovary. In plain terms:
- 58570: TLH, uterus 250 g or less, uterus only.
- 58571: TLH, uterus 250 g or less, plus removal of tube(s) and/or ovary(s).
- 58572: TLH, uterus greater than 250 g, uterus only.
- 58573: TLH, uterus greater than 250 g, plus removal of tube(s) and/or ovary(s).
The distinction matters because a heavier uterus requires more operative work, more morcellation or different extraction techniques, and a longer procedure. When a surgeon removes ovaries or tubes alongside the uterus, the procedure is more involved than uterus-only removal, and the code reflects that additional complexity. Because many hysterectomies today include at least a bilateral salpingectomy (tube removal) for ovarian cancer risk reduction, 58571 and 58573 are used frequently. The weight cutoff is based on the actual specimen weight measured after removal, not a preoperative estimate, though surgeons do try to estimate weight beforehand to plan appropriately.
What the Procedure Involves
A total laparoscopic hysterectomy means the entire uterus, including the cervix, is removed through small abdominal incisions using a camera and specialized instruments, with no large open incision. The word “total” refers to taking the cervix along with the uterine body, as opposed to a subtotal (supracervical) hysterectomy that leaves the cervix in place. The first laparoscopic hysterectomy was performed by Harry Reich in Pennsylvania in 1988, and the technique has evolved considerably since then.1PubMed Central. Hysterectomy: a historical perspective
The patient is placed in a dorsal lithotomy position, tilted steeply head-down (Trendelenburg) so the intestines fall away from the pelvis, giving the surgeon a clear view. A foam mattress prevents the patient from sliding. The surgeon typically works through three or four small incisions, each about 5 to 12 millimeters, one at or near the navel for the camera and two or three on either side of the lower abdomen for instruments.2PubMed Central. Total Laparoscopic Hysterectomy: 10 Steps Toward a Successful Procedure A uterine manipulator inserted vaginally helps angle the uterus during the operation. The surgeon seals and cuts the blood supply, detaches the uterus from its supporting ligaments, separates it from the bladder and ureters, cuts around the cervix at the top of the vagina, and removes the specimen through the vaginal canal. If tubes and ovaries are being removed (as in 58571), the surgeon also divides the ovarian blood supply and detaches those structures before extraction. The vaginal cuff is then sutured closed laparoscopically.
Common Reasons for the Surgery
Total laparoscopic hysterectomy is performed for a range of benign gynecological conditions. In a large series of 783 TLH cases at a Turkish university hospital, the most common indication was uterine fibroids, accounting for about 31% of cases, followed closely by abnormal uterine bleeding at roughly 30%.3Clinical and Experimental Obstetrics & Gynecology. Analysis of 783 Cases of Total Laparoscopic Hysterectomy for Benign Indications: Experience from a Turkish University Hospital Other reasons include endometriosis, adenomyosis, pelvic organ prolapse, and chronic pelvic pain that has not responded to conservative treatment. The American College of Obstetricians and Gynecologists (ACOG) recommends that minimally invasive approaches, including laparoscopic hysterectomy, should be used whenever feasible because of their documented advantages over open abdominal surgery.4PubMed. Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease
How TLH Compares to Open Abdominal Hysterectomy
The biggest practical differences between TLH and the traditional open approach show up in blood loss, hospital stay, and recovery time, though the tradeoff is a longer time in the operating room. One comparative study found that TLH took an average of about 105 minutes versus 74 minutes for abdominal hysterectomy, but patients who had the laparoscopic approach went home in roughly two and a half days compared to nearly five days for the open group. Complication rates were similar between the two, and TLH patients had higher hemoglobin levels after surgery, reflecting less blood loss.5PubMed Central. Comparison of total laparoscopic hysterectomy and abdominal hysterectomy Another study confirmed significantly lower blood loss in the TLH group (averaging about 216 mL versus 371 mL for abdominal hysterectomy) and shorter hospitalization.6Journal of Shalamar Medical & Dental College – JSHMDC. Comparison of Outcomes of Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy
The faster recovery translates to less time away from work and daily activities. Most patients resume normal routines within two to four weeks after TLH, compared to six or more weeks after an open procedure. The smaller incisions also mean less wound pain and a lower risk of wound complications like hernias or infections.
How TLH Compares to Vaginal Hysterectomy
Vaginal hysterectomy, where the uterus is removed entirely through the vagina with no abdominal incisions at all, is often considered the least invasive option. A systematic review and meta-analysis comparing the two found no difference in overall complications, length of hospital stay, or recovery time. Vaginal hysterectomy did have a shorter operating time and lower pain scores at the 24-hour mark.7PubMed Central. Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review and meta-analysis A separate systematic review noted that vaginal hysterectomy also tends to cost less and involves less blood loss, but TLH offers better postoperative satisfaction scores and may be the better choice when there are adhesions, adnexal masses, or when a narrow pelvis makes the vaginal route technically difficult.8PubMed Central. Comparative Analysis of Total Laparoscopic Hysterectomy Versus Non-descent Vaginal Hysterectomy for Benign Uterine Pathologies in Women: A Systematic Review
In practice, the vaginal route is not always anatomically feasible. Endometriosis, a very large uterus, prior pelvic surgery, or the need to evaluate and remove the ovaries or tubes can all tip the decision toward laparoscopy. ACOG’s recommendation hierarchy puts vaginal hysterectomy first when possible, laparoscopic approaches second, and open abdominal surgery as the last resort.
Robotic-Assisted Versus Conventional Laparoscopic Hysterectomy
Robotic-assisted hysterectomy uses the same small incisions as conventional TLH but adds a robotic surgical system that gives the surgeon wristed instrument movement and three-dimensional visualization. From a coding standpoint, robotic-assisted total laparoscopic hysterectomy is generally reported using the same CPT codes (58570–58573), not a separate set. The distinction between “robotic” and “conventional laparoscopic” lives in the operative note and sometimes in a modifier, not in a fundamentally different CPT number.
The clinical question is whether the robot adds value. A matched case-control study found that robotic hysterectomy took longer (about 109 minutes versus 83 minutes for conventional laparoscopic) and cost nearly double at the facility studied (roughly €4,067 versus €2,151), with only slightly shorter hospital stays.9PubMed. Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study However, the picture shifts with larger uteri. A study stratifying by uterine weight found that for uteri between 750 and 1,000 grams, robotic hysterectomy was about 81 minutes faster and roughly $1,859 cheaper than conventional laparoscopic surgery, with even larger advantages beyond 1,000 grams.10PubMed. Comparison of cost and operative outcomes of robotic hysterectomy compared to laparoscopic hysterectomy across different uterine weights For a standard 58571 case involving a uterus under 250 grams, the robot’s advantages over conventional laparoscopy are less clear-cut, and the added cost is harder to justify on outcomes data alone.
Complications and Safety
TLH is a safe procedure overall, but complications can occur. The most talked-about risk specific to laparoscopic hysterectomy is ureteral injury, where a ureter (the tube carrying urine from kidney to bladder) is accidentally cut, kinked, or thermally damaged during dissection. The ureters run close to the uterine arteries and cervix, and the laparoscopic approach, while offering magnified views, uses energy devices that can cause thermal spread. Risk factors for ureteral injury include endometriosis, large fibroids, prior pelvic surgery, and anything else that distorts the normal anatomy. Notably, about half of patients who sustain ureteral injuries have no identifiable risk factors beforehand.11PubMed Central. Ureteral Injury in Laparoscopic Gynecologic Surgery
The actual rate depends heavily on surgeon experience. A retrospective study of high-volume fellowship-trained minimally invasive gynecologic surgeons found a ureteral injury rate of just 0.04%, well below national averages.12PubMed. Very Low Rates of Ureteral Injury in Laparoscopic Hysterectomy Performed by Fellowship-trained Minimally Invasive Gynecologic Surgeons Another series from a single hospital over 12 years reported 7 ureteral injuries out of 1,135 TLH cases, a rate of about 0.6%.13PubMed Central. Ureter Injury in Total Laparoscopic Hysterectomy That range, from under 0.1% in expert hands to around 0.5–1% in broader practice, reflects the reality that surgeon volume and training matter a lot in minimally invasive gynecologic surgery.
Other potential complications include bleeding requiring transfusion, bladder injury, vaginal cuff dehiscence (the sutured vaginal closure opening up after surgery), bowel injury, and port-site complications like hernia or infection. Most studies put the overall complication rate for TLH in the range of 3–10%, with the majority being minor and manageable.
Recovery and Pain Patterns After TLH
Recovery from TLH is generally faster than from open surgery, but the pain pattern has some quirks that catch patients off guard. A prospective study tracking pain in detail after TLH found that abdominal incision pain and deep visceral pain were worst on the day of surgery and improved steadily from there. Shoulder pain, though, followed a different trajectory: it gradually built up and peaked around 24 hours after surgery, affecting 90% of patients. Right shoulder pain was worse than left. This shoulder pain comes from carbon dioxide gas used to inflate the abdomen during the procedure, which irritates the diaphragm, and that irritation is referred to the shoulder via the phrenic nerve.14PubMed Central. Pain Characteristics after Total Laparoscopic Hysterectomy
Another finding from the same study that surprises many patients: perineal pain was reported by 92% of participants and was rated as more severe than abdominal pain in about 30% of them. This likely results from the uterine manipulator used vaginally during the procedure and from the vaginal cuff closure. Patients who had a regular exercise habit before surgery had a higher tolerance for shoulder pain, suggesting that preoperative fitness may genuinely help with one of the more bothersome post-TLH discomforts.
Most patients go home one to two days after surgery. Activity restrictions typically include avoiding heavy lifting and vaginal intercourse for several weeks while the vaginal cuff heals. Full recovery, meaning return to all normal activities without restriction, is usually around four to six weeks.
Long-Term Effects on Sexual and Pelvic Floor Function
One of the most common concerns patients raise before hysterectomy is whether it will affect sexual function. A five-year follow-up study found that overall sexual function scores did not change significantly after hysterectomy. However, the picture was more nuanced at the individual level: women who were sexually active before surgery reported a decline in function over the five years, while women who had not been sexually active before surgery actually reported improvement. Pelvic floor symptoms improved substantially, with bother scores dropping by more than 50% over five years. The route of hysterectomy, whether robotic-assisted TLH, conventional TLH, or open abdominal, had no impact on either pelvic floor or sexual function outcomes at five years.15PubMed Central. Sexual function and pelvic floor function five years after hysterectomy
A related question is whether keeping the cervix (subtotal hysterectomy) leads to better sexual outcomes than total hysterectomy. A study comparing the two laparoscopic approaches found that preserving the cervix did not confer a sexual function advantage. Both total and subtotal hysterectomy produced comparable improvements in sexual function, particularly in patients who had impaired sexuality before surgery. Patient expectations going in seemed to influence postoperative outcomes, which underscores how much the preoperative counseling conversation matters.16PubMed. Sexual functioning after total versus subtotal laparoscopic hysterectomy
Uterine Weight Estimation and Why the 250-Gram Cutoff Matters
The 250-gram dividing line between 58570/58571 and 58572/58573 exists because operating on a larger uterus takes more time, requires more dissection, and presents different extraction challenges. A normal-sized uterus weighs roughly 60 to 80 grams; one with fibroids can easily weigh several hundred grams or more. Estimating uterine weight before surgery helps with procedure planning and, afterward, determines which code is used for billing.
A study comparing ultrasound measurements to clinical (bimanual) exam estimates found that all methods correlated with actual weight, but the clinical estimate by an experienced examiner was actually the best predictor.17PubMed. Predicting uterine weight before hysterectomy: ultrasound measurements versus clinical assessment In practice, the final specimen weight recorded by pathology is what determines the correct CPT code. If a surgeon expects the uterus to be under 250 grams but the pathology report comes back at 280 grams, the code should be adjusted to 58572 or 58573 accordingly.
Billing Nuances and Modifier 22
When the procedure is substantially more difficult or time-consuming than the standard case, surgeons can append modifier 22 to the CPT code to indicate increased procedural complexity and request higher reimbursement. An analysis of fee-for-service Medicare claims found that laparoscopic total abdominal hysterectomy with bilateral salpingo-oophorectomy had the highest rate of modifier 22 use among the procedures studied, at about 8.5% of claims.18PubMed Central. Modifier 22 Use in Fee-for-Service Medicare That high rate is not surprising given how variable hysterectomy complexity can be: dense adhesions from prior surgery, severe endometriosis, very large fibroids, or morbid obesity can all turn a routine case into a prolonged one. Supporting documentation in the operative note, including specific reasons for the added difficulty and the extra time required, is essential for modifier 22 claims to be accepted by payers.
Another common coding question is when to bill separately for salpingectomy (tube removal). When tubes are removed as part of a 58571 procedure, the tube removal is bundled into the hysterectomy code. You would not separately report a salpingectomy code on top of 58571. However, if a surgeon performs an incidental appendectomy or treats endometriosis extensively during the same session, those additional procedures may warrant separate codes with appropriate modifiers.
The Morcellation Question
When a uterus is too large to fit through the vaginal canal or the small laparoscopic port incisions intact, the surgeon may need to cut it into smaller pieces for removal, a process called morcellation. This became controversial when it was recognized that, in rare cases, an unsuspected uterine cancer could be spread throughout the abdomen during uncontained morcellation. The FDA issued a safety communication in 2014 discouraging the use of laparoscopic power morcellation and later, in 2020, issued final guidance recommending that power morcellation for myomectomy or hysterectomy be performed only with a tissue containment system and in appropriately selected patients.19PubMed Central. Vaginal power morcellation using a contained bag system: a novel surgical technique
For a 58571 case, where the uterus weighs 250 grams or less, morcellation is generally unnecessary since the specimen can often be delivered intact through the vagina. This is actually one of the practical advantages of operating on a smaller uterus. When morcellation is needed for larger uteri (58572 or 58573 territory), contained bag systems are now the standard approach.
The Learning Curve for Surgeons
TLH is technically more demanding than open or vaginal hysterectomy, and there is a well-recognized learning curve. A study tracking surgical residents in a high-volume training program found that the majority of cases took between 61 and 120 minutes, with an intraoperative complication rate of about 3% and a postoperative complication rate of about 7.6%.20PubMed Central. Learning Curve of Total Laparoscopic Hysterectomy for a Resident in a High-Volume Resident Training Setup Published learning curve analyses generally suggest that operative times and complication rates plateau after somewhere between 20 and 75 cases, depending on the complexity of cases and the training environment. The wide range reflects the reality that structured, supervised training in a high-volume center shortens the curve considerably compared to surgeons learning in lower-volume settings.
For patients, this is practical information. Asking a surgeon about their volume of laparoscopic hysterectomies and their fellowship training is entirely reasonable and relevant to outcomes. The difference in ureteral injury rates between high-volume fellowship-trained surgeons and the broader average, as discussed earlier, is a real-world illustration of why experience matters.
Cost Differences Across Hysterectomy Approaches
Total patient costs vary substantially by approach. A large analysis found mean total costs of about $43,600 for abdominal hysterectomy, $31,900 for vaginal, $38,300 for laparoscopic, and $49,500 for robotic hysterectomy. Costs were driven primarily by the method used, operative time, and length of hospital stay.21PubMed Central. Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies Vaginal hysterectomy was the least expensive. Conventional laparoscopic hysterectomy fell in the middle, costing less than abdominal when shorter hospital stays offset longer operative times. Robotic hysterectomy was the most expensive, largely because of the capital cost of the robotic system and the disposable instruments it requires. These figures represent total costs including hospital stay and are higher than what any individual patient would see as their out-of-pocket responsibility, but they shape insurance negotiations and institutional decisions about which approaches to prioritize.
From an individual patient’s perspective, what matters most is usually the out-of-pocket responsibility under their specific insurance plan, the days of missed work, and the indirect costs of a longer recovery. When comparing a 58571 TLH to an open alternative, the shorter hospital stay and faster return to activity often offset the slightly higher surgical costs, particularly for patients who cannot afford extended time away from work or caregiving responsibilities.