CPT® Code 58662

Quick Reference

• Code definition: CPT 58662 covers laparoscopic surgical fulguration or excision of lesions on the ovary, pelvic viscera, or peritoneal surface by any method, including electrocautery, laser, harmonic scalpel, and sharp excision [1].
• Key billing rule: MUE is 1 per date of service (Type 2, policy-based, anatomic consideration); multiple lesion sites across the ovary, pelvic viscera, and peritoneum are all captured by a single unit [2].
• Global period: 90-day major surgery global; pre-op day, operative day, and 90 post-op days are bundled. Routine follow-up during this window is not separately billable.
• Modifier essentials: Modifier 22 for documented complexity exceeding typical service; modifier 58 for staged procedures during the global period; modifier 62 for co-surgeons (permitted, no additional documentation required if two-specialty requirement is met); modifiers 80/82 for assistant surgeons (no Medicare payment restriction applies) [1].
• Top confusion point: Do not bill 49320 separately with 58662. Diagnostic laparoscopy is the endoscopic base code and is always bundled into any surgical laparoscopy; this is one of the most common NCCI edit violations for this code [1].
• Bilateral alert: The bilateral indicator for 58662 is 0; the 150% bilateral payment adjustment does NOT apply. Do not append modifier 50 even when bilateral pelvic disease is present [1].
• Multiple endoscopic procedures: When additional laparoscopic procedures are performed at the same session, Multiple Procedures Indicator 3 governs, not the standard 50% reduction (Indicator 2). Each additional procedure is paid at its fee schedule amount minus the 49320 base value [1].

When to Use This Code

CPT 58662 is the correct code whenever a surgeon performs laparoscopic fulguration or excision of pathological tissue from the ovary, pelvic viscera (uterus, fallopian tube, bladder, bowel, ureter, broad ligament), or peritoneal surface. The "by any method" language is intentional: the code applies regardless of whether the surgeon uses bipolar electrocautery, monopolar cautery, laser ablation, harmonic scalpel, or cold scissors excision.

Primary indications include:

• Endometriosis with implants on ovarian surface, peritoneum, cul-de-sac, or visceral structures (most frequent indication)
• Ovarian surface lesions, paratubal cysts, and parovarian cysts not requiring oophorectomy
• Peritoneal surface deposits, implants, or lesions requiring destruction or removal
• Pelvic adhesions where excision of adhesive disease is the primary focus (see differentiation section for interaction with 58660)

What this code does not capture:

• Removal of the ovary or fallopian tube — once an adnexal structure is removed (oophorectomy or salpingectomy), the correct code is 58661, not 58662
• Purely diagnostic laparoscopy with no treatment — report 49320 only
• Tubal ligation/sterilization procedures — 58670 (fulguration of oviducts) or 58671 (occlusion by device) are the correct codes for sterilization intent

This code is performed in ASC and hospital outpatient settings under general anesthesia. CMS has approved it for ASC payment since CY 2007 at OPPS-weighted rates. Hospital outpatient claims are paid through a comprehensive APC [1]. There is no facility-versus-non-facility PE differential for this code; RVUs are 19.36 total in both settings for 2026 [1].

Code Differentiation Table

The critical read is the operative report: if the surgeon destroys or removes lesion tissue but leaves the ovary and tube intact, 58662 is correct. If the organ is excised in whole or in part, 58661 governs. These two codes are frequently miscoded in endometrioma cases where the surgeon removes the cyst wall but preserves ovarian tissue; that is 58662 (excision of lesion of ovary), not 58661.

Billing & Modifier Rules

Modifier 22 (Increased Procedural Services)

Modifier 22 is appropriate when documented complexity substantially exceeds the typical 58662 service, most commonly in extensive endometriosis cases with multi-organ involvement, dense adhesion formation, or significantly prolonged operative time. Documentation must specifically quantify the increased complexity; a generic statement that the procedure was "difficult" will not sustain the modifier on audit. The carrier will review operative records before paying the increased amount. Attach a cover letter with the claim quantifying additional time and complexity [1].

Modifier 51 (Multiple Procedures)

Do not apply modifier 51 to 58662 or secondary laparoscopic procedures billed alongside it. The Multiple Procedures Indicator for 58662 is 3, meaning special endoscopic payment adjustment rules apply instead of the standard 50% reduction. When 58662 is billed with additional surgical laparoscopies (e.g., 58660), the highest-valued procedure is paid at 100% of the fee schedule; each lesser-valued procedure is paid at its fee schedule amount minus the base diagnostic laparoscopy (49320) value [1].

Modifier 58 (Staged Procedure)

When the surgical plan requires a second laparoscopy during the 90-day global period, append modifier 58 to 58662 for the subsequent procedure. This opens a new 90-day global period and allows separate payment. Staged intent should be documented in the original operative report or a separate treatment plan.

Modifier 59 (Distinct Procedural Service) and X-Modifiers

When 58660 (lysis of adhesions) is performed alongside 58662 and is subject to an NCCI PTP edit, modifier 59 or the appropriate X-modifier (XS for separate structure, XU for non-overlapping service) may establish separate reportability. Documentation must support that adhesiolysis constituted a distinct, medically necessary service beyond the standard access work for the lesion excision.

Modifier 62 (Co-Surgeons)

Co-surgeon billing is permitted for 58662 with no additional documentation required when the two-specialty requirement is met [1]. Each surgeon bills 58662-62 and receives 62.5% of the Medicare fee schedule amount. A common scenario is gynecologic oncologist plus urologist for endometriosis involving the ureter.

Modifiers 80/82 (Assistant Surgeon)

No Medicare payment restriction applies to assistant surgeons for this procedure (indicator 2). Bill 58662-80 or 58662-82 as applicable [1].

MUE and Units

The MUE is 1 per date of service, Type 2 (Date of Service Edit: Policy), based on anatomic consideration [2]. Billing more than one unit of 58662 on the same date will deny. All lesion sites treated through the same laparoscopic access are captured by a single unit, regardless of how many discrete lesions or how many anatomical locations are treated.

Add-On Code 49327

49327 (placement of interstitial device(s) for radiation therapy guidance, intra-abdominal/intrapelvic) may be reported in addition to 58662 when applicable. It is a true add-on code requiring a primary procedure.

Bilateral Modifier

The bilateral indicator for 58662 is 0; do not append modifier 50. Bilateral ovarian or peritoneal disease does not trigger bilateral payment adjustment for this code [1].

Documentation Essentials

Required operative report elements:

• Surgical approach confirmed as laparoscopic (not converted to open)
• Specific anatomical site(s) of each lesion treated (ovary vs. peritoneal surface vs. pelvic viscera; laterality when relevant to diagnosis coding)
• Method of treatment used (laser, bipolar electrocautery, monopolar, sharp excision, harmonic scalpel)
• Lesion description (appearance, size when measurable, tissue characteristics)
• Whether tissue was excised and sent to pathology or destroyed in situ
• Confirmation that pneumoperitoneum was established and the cavity was inspected
• Findings on inspection of all pelvic structures (not only the treated site)
• Any complications encountered
• Instrument withdrawal and incision closure

Diagnosis documentation:

ICD-10-CM specificity drives both claim payment and audit outcomes. Since FY2023, the parent endometriosis codes N80.0, N80.1, and N80.3 are deleted [3]. The operative report must document sufficient detail to assign current sub-codes: site, laterality, and depth (superficial vs. deep infiltrating) when assessable. If pathology is obtained, ICD-10-CM coding should be reconciled against the confirmed pathological diagnosis.

Audit red flags specific to 58662:

• Operative report does not specify the method of destruction/excision (auditors will question whether the procedure meets the surgical laparoscopy threshold vs. diagnostic only)
• Diagnosis code is vague pelvic pain without documented pelvic pathology findings in the operative report
• 49320 billed on the same date; this is an automatic NCCI denial and signals broader coding errors to payers
• Modifier 50 appended (bilateral indicator is 0; this flags the claim for review)
• Modifier 22 without a specific, quantified complexity narrative in the operative note or cover letter
• Post-op E/M visits billed within 90-day global period without modifier 24 (unrelated service)

Medical necessity:

The clinical record prior to surgery must establish that conservative management was attempted or was inappropriate. For endometriosis, this typically means documented history of hormonal therapy, pain management, or prior imaging/diagnosis confirming the condition. A claim supported only by a symptom code (pelvic pain) without pre-operative findings will draw scrutiny on medical necessity review.

Medicare, Commercial & Medicaid Payer Rules

Medicare

CMS classifies 58662 as a major surgery with a 90-day global period [1]. The 2026 Medicare payment is approximately $646.64 based on a total RVU of 19.36 and a conversion factor of $33.4009 [1]. Payment applies in both facility and non-facility settings at the same rate (facility and non-facility PE RVUs are identical for this code).

CPT 58662 appears on the ASC-approved procedure list since CY 2007; ASC payment is based on the OPPS relative payment weight [1]. Hospital outpatient payment is through a comprehensive APC.

No CMS National Coverage Determination (NCD) specifically restricts 58662 [1]. Coverage is determined under the reasonable and necessary standard. MAC-specific Local Coverage Determinations (LCDs) may apply; coders should verify with the applicable MAC jurisdiction for their geographic region.

CMS permits co-surgeon billing (modifier 62) and assistant surgeon billing (modifiers 80/82) with no payment restriction for this code [1].

Commercial Payers

Commercial payers generally follow Medicare's endoscopic bundling framework, but prior authorization requirements vary significantly. Many commercial plans require prior authorization for elective laparoscopic surgery, including for endometriosis. Failure to obtain authorization is a leading cause of denial that cannot be corrected post-service with modifier submission.

Some commercial payers apply diagnosis-specific coverage restrictions for laparoscopic excision of endometriosis, requiring documented failure of hormonal therapy or a prior diagnostic laparoscopy confirming disease. Verify plan-specific policies before scheduling.

Medicaid

Medicaid fee schedules and prior authorization requirements vary by state and managed Medicaid plan. No state-specific policies for 58662 were confirmed in the research document; verify with the applicable state program or managed care organization.

Common Denials & Prevention

Denial: NCCI Bundling (49320 billed with 58662)

The most common denial pattern for this code. Diagnostic laparoscopy is the endoscopic base code for 58662; billing both on the same date violates NCCI edits automatically. Remove 49320 from any claim that includes 58662 or any other surgical laparoscopy [1]. No modifier can override this edit; the diagnostic component is definitionally included in the surgical laparoscopy.

Denial: Medical Necessity (Insufficient Diagnosis Support)

Occurs when the ICD-10-CM code on the claim does not adequately support the clinical need for surgical laparoscopy. A standalone symptom code without a confirmed pelvic diagnosis is the primary trigger. Prevention: ensure the diagnosis code reflects the confirmed condition documented in the operative report and pre-operative workup. If endometriosis is confirmed intraoperatively for the first time, that confirmed diagnosis (not the presenting symptom) should be the primary code.

Denial: Invalid ICD-10-CM Code (Deleted Codes)

Claims submitted with deleted endometriosis parent codes (N80.0, N80.1, N80.3 deleted effective 10/1/2022) reject at the payer edit level [3]. Update to current-year sub-codes specifying site, laterality, and depth. Review chargemaster and code sets annually for deleted codes in the N80 range.

Denial: Global Period Violation (Post-op E/M Without Modifier)

Routine follow-up E/M visits within the 90-day global period are included in the 58662 fee and will deny if billed without modifier 24 (unrelated condition) or modifier 79 (unrelated procedure). Document that any separately billed service during the global window is for a condition unrelated to the laparoscopic procedure. For unrelated procedures requiring return to the OR, use modifier 78 (related complication) or 79 (unrelated) as appropriate.

Denial: Modifier 22 Rejected Without Documentation

Carriers will hold or deny claims with modifier 22 pending medical record review. A modifier 22 claim submitted without a cover letter quantifying the increased complexity will stall. Prevention: attach a written explanation of the specific factors that increased procedural work (operative time vs. typical, number of structures involved, extent of disease, anatomical difficulty) with every modifier 22 submission.

Coding Scenarios

Scenario 1: A patient with known endometriosis and dysmenorrhea undergoes laparoscopy. The surgeon identifies and ablates superficial endometrial implants on the right ovary surface and the anterior cul-de-sac using bipolar electrocautery. The ovary and tubes are left intact.

Correct coding: 58662 + N80.101 (endometriosis of right ovary, unspecified depth) + N80.319 (endometriosis of anterior cul-de-sac, unspecified depth)

Why: A single unit of 58662 captures all lesion sites treated through the same laparoscopic access. Both anatomical sites are reported in the diagnosis list because the FY2023 ICD-10-CM expansion requires site-specific codes. Do not bill 49320 separately.

Scenario 2: A patient undergoes laparoscopy for a right ovarian endometrioma (4 cm). The surgeon performs cystectomy of the endometrioma cyst wall, preserving normal ovarian cortex, and excises several peritoneal surface implants. The ovary remains in place.

Correct coding: 58662 + N80.101

Why: Removing the cyst wall while leaving the ovary is excision of a lesion of the ovary (58662), not removal of adnexal structures (58661). Code 58661 applies only when the ovary or tube itself is resected. If pathology confirms endometrioma, N80.101 (or laterality/depth-specific variant) is appropriate.

Scenario 3: A patient with endometriosis and dense pelvic adhesions undergoes laparoscopy. The surgeon spends 45 minutes lysing extensive bowel and pelvic sidewall adhesions, then excises ovarian and peritoneal endometriotic lesions. The operative note separately describes the adhesiolysis as requiring significant dissection due to the density and vascularity of the adhesions.

Correct coding: 58662 + 58660-59 + N80.109 + N73.6

Why: When adhesiolysis constitutes a distinct, documented surgical service beyond routine access work, 58660 may be separately reportable with modifier 59. Apply Multiple Procedures Indicator 3 endoscopic reduction rules: 58662 pays at 100%; 58660 pays at (58660 fee schedule minus 49320 base value). Verify current NCCI PTP edit status for this pair before billing.

Scenario 4: A gynecologic oncologist and urologist operate together laparoscopically to excise deep infiltrating endometriosis involving the ureter. Both surgeons perform distinct portions of the dissection throughout the case.

Correct coding: Both surgeons bill 58662-62 + appropriate endometriosis ICD-10-CM code(s) for sites involved

Why: Co-surgeon billing is permitted for 58662 (indicator 2) without additional documentation when the two-specialty requirement is met (gynecology and urology qualify) [1]. Each surgeon receives 62.5% of the Medicare allowable. If either surgeon provides only minimal assistance rather than performing a distinct portion of the procedure, modifier 80 or 82 is more appropriate than modifier 62.

Related Codes

• 49320 — Diagnostic laparoscopy, abdomen; endoscopic base code for 58662, always bundled, never separately billable on the same date
• 49327 — Laparoscopy with placement of interstitial device for radiation guidance; add-on code reportable in addition to 58662 when applicable
• 58660 — Laparoscopy with lysis of adhesions; may be separately reportable at same session with modifier 59 when documented as distinct service
• 58661 — Laparoscopy with removal of adnexal structures (oophorectomy/salpingectomy); use when the ovary or tube is removed rather than a lesion excised from it
• 58670 — Laparoscopy with fulguration of oviducts; tubal sterilization by cautery, not pelvic lesion treatment
• 58671 — Laparoscopy with occlusion of oviducts by device; tubal sterilization, distinct from 58662
• N80.101 — Endometriosis of right ovary, unspecified depth; primary diagnosis for most 58662 claims for endometriosis
• N80.319 — Endometriosis of anterior cul-de-sac, unspecified depth; commonly paired for peritoneal involvement

Sources

1. CMS 2026 Physician Fee Schedule PPRRVU File (January Release, Non-QPP), released 12/29/2025. RVU values, global days, multiple procedures indicator, bilateral indicator, co-surgeon/assistant indicators, APC and ASC status for CPT 58662.
2. CMS NCCI MUE Practitioner Services Table, effective 04-01-2026. MUE value (1), edit type (Date of Service, Policy, Type 2), rationale (Anatomic Consideration) for CPT 58662.
3. CMS ICD-10-CM FY2023 Code Updates, effective 10/1/2022. Deletion of parent codes N80.0, N80.1, N80.3; addition of expanded site-specific, laterality-specific, and depth-specific sub-codes under the N80 Endometriosis category.