CPT 58100 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Female Genital System |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AG - Primary physician • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 58100 |
National average reimbursement for CPT 58100 by major payers:
$122.26
$137.66
$146.16
$172.70
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 58100 | ||||||
United | 58100 | $122.89 | 1306391610 - CAMILLA GRANT | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 58100 | $136.55 | 1114926292 - JEFFREY BERG | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Sports Medicine (Orthopaedic Surgery) Physician (207XX0005X) |
United | 58100 | $74.83 | 1144750092 - KRISTINE HAYS | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 58100 | $175.91 | 1861735615 - JESSICA SASSANI | 251838458 - HIGHMARK HEALTH | PA | Obstetrics & Gynecology Physician (207V00000X) |
United | 58100 | $162.88 | 1164842415 - KARNIKA AYINAPUDI | 350593390 - DEACONESS HOSPITAL INC | IN | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 58100 | $124.26 | 1073154266 - MADISON CO MEMORIAL HOSPITAL, SEASONS MEDICAL BY MADISON MEMORIAL | 820517398 | ID | Obstetrics & Gynecology Physician (207V00000X) |
United | 58100 | $137.19 | 1366437493 - GEORGE KARTALIAN, JR. | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopaedic Surgery Physician (207X00000X) |
United | 58100 | $566.00 | 1205949245 - MEMORIAL SURGERY CENTER, LLC | 201167151 - (OK) MEMORIAL SURGERY CENTER LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58100 | $216.96 | 1487668067 - ASHANDA SAINT JEAN | 264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 58100 | $162.88 | 1477592418 - DEACONESS HOSPITAL, INC, <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 58100 | $448.89 | 1154693786 - KIRAN KAVIPURAPU | 954373070 | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 58100 | $219.53 | 1902826001 - DORI BECKER | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Obstetrics & Gynecology Physician (207V00000X) |
United | 58100 | $214.27 | 1205241932 - MEREDITH CARBONE-DOYLE | 61470493 | MI | Obstetrics & Gynecology Physician (207V00000X) |
United | 58100 | $342.00 | 1073845087 - EYE SURGERY CENTERS OF ARIZONA, LLC, EYE SURGERY AT THE BILTMORE, LLC | 271798256 - (AZ) EYE SURGERY CENTERS OF ARIZONA 401(K) PROFIT SHARING PLAN & TRUST | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 58100 | $346.33 | 1285892448 - AUNDREA MARRA | 562120710 | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 58100 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 58100 code is part of the Surgery services used for Surgical Procedures on the Female Genital System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 58100 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 57720-CPT | Moderate | Trachelorrhaphy Vaginal Appr |
| 57800-CPT | Low | Dilation Cervical Canal |
| 58100-CPT | Low | Endometrial Sampling (Biopsy) With Or Without Endocervical Sampling (Biopsy), Without Cervical Dilation, Any Method (Separate Procedure) |
| 58345-CPT | Moderate | Transcervical Introduction Of Fallopian Tube Catheter For Diagnosis And/Or Re-Establishing Patency (Any Method), With Or Without Hysterosalpingography |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 58100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 58100 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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