CPT 58356 Fee Schedule
Last Updated: August 2025
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 59 - Distinct Procedural Service • AS - Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) assistant at surgery services • 51 - Multiple procedures • 52 - Partially Reduced/Eliminated Services |
| Complexity Level | High |
National average reimbursement for CPT 58356 by major payers:
$2,002.04
$2,564.09
$2,387.76
$3,065.68
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Related Codes
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 58356. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 58356 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.
CPT 58356 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 58356 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 58356 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 58263 | High | Vaginal Hysterectomy, For Uterus 250 G Or Less; With Removal Of Tube(S), And/Or Ovary(S), With Repair Of Enterocele |
| 58294 | High | Vaginal Hysterectomy, For Uterus Greater Than 250 Grams With Repair Of Enterocele |
| 58301 | Low | Removal Intrauterine Device |
| 58356 | High | Endometrial Cryoablation With Ultrasonic Guidance, Including Endometrial Curettage, When Performed |
See what providers are getting paid in 2025 for 58356:
CPT 58356 Fee Schedule & Reimbursement Rates
The CPT 58356 fee schedule varies by payer type. Below are Medicare rates for 2025 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. BCBS National Rate | More Info |
|---|---|---|---|
| 58263 | $997.29 | $1,280.55 | |
| 58294 | $1,218.66 | $1,527.69 | |
| 58301 | $110.85 | $125.29 | |
| 58350 | $154.79 | $156.69 | |
| 58353 | $920.07 | $1,117.33 | |
| 58356 | $1,660.71 | $2,002.04 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is Price Transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). This landmark regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
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