CPT Code for Tubal Reanastomosis

If you are reading this, you probably have a patient who regrets a previous tubal ligation. Maybe she has a new partner. Maybe her circumstances have changed. Whatever the reason, she wants to restore her fertility. And that means she is asking about tubal reanastomosis.

As a coder or a biller, your job is clear. You need to translate that complex microsurgery into a simple number: the correct CPT code.

But here is the catch. Tubal reanastomosis is not a one-size-fits-all procedure. The code changes depending on what the surgeon finds inside. Use the wrong code, and you face claim denials, audits, or lost revenue.

Do not worry. This guide walks you through everything you need to know. We will cover the primary codes, the differences between them, and the real-world documentation you need to support your claim.

Let us get started.

What Is Tubal Reanastomosis Exactly?

Before we talk about codes, let us talk about the surgery. Tubal reanastomosis is also called tubal reversal. The surgeon reopens, cleans, and rejoins the fallopian tubes after a prior tubal ligation.

Think of it like repairing a cut garden hose. The surgeon removes the blocked or clipped portion of each tube. Then, using very fine sutures and a microscope, they reconnect the healthy ends. The goal is to create a open, functional passage for the egg and sperm to meet.

This is delicate work. It requires precision. And it takes time.

Why Patients Choose This Over IVF

You might wonder why someone would choose surgery over in vitro fertilization (IVF). Both are valid options. But some patients prefer reversal because:

• It allows for repeated natural conception attempts.

• It can be more cost-effective if the patient wants more than one child.

• It avoids the hormonal medications required for IVF.

As a coder, you do not need to judge the choice. You just need to document the medical necessity clearly.

The Primary CPT Code for Tubal Reanastomosis

Let us answer the main question directly.

The most common CPT code for tubal reanastomosis is 58750.

That is the code you will use in the vast majority of cases.

CPT 58750: The Detailed Definition

The official CPT manual describes 58750 as:

“Tubotubal anastomosis (reversal of previous sterilization).”

Simple, right? But there is a hidden detail. Code 58750 is for a unilateral procedure. That means one side. However, almost all tubal reversals are performed on both tubes. So why would you use a unilateral code?

You would use 58750 for each side. But you cannot simply bill it twice. You must use a modifier. Specifically, you append modifier 50 to indicate a bilateral procedure.

Correct billing example:

• 58750-50 (Bilateral tubotubal anastomosis)

If you bill without modifier 50, the payer may assume you only worked on one tube. That would reduce your reimbursement by half.

What 58750 Includes

When you bill 58750, the following work is included in the reimbursement. You cannot bill these separately:

• Lysis of adhesions (freeing the tube from scar tissue)

• Removal of the old ligation clips or rings

• Resection of the damaged tubal segment

• Reapproximation of the healthy tubal segments

• Placement of sutures under microscopy

• Checking tubal patency (often with chromotubation)

Do not add separate codes for these tasks. They are bundled.

The Secondary Code: 58752

There is another code you need to know. It is 58752.

This code is for tubal anastomosis after a previous ectopic pregnancy or salpingectomy. In other words, the patient did not have a tubal ligation. She lost a segment of tube due to disease or trauma.

The official description is:

“Tubotubal anastomosis (reversal of previous sterilization) – different from 58750 by medical necessity.”

Wait, that sounds almost identical. So what is the difference?

58750 vs. 58752: The Real Difference

The surgical technique is the same. The sutures are the same. The microscope is the same. The difference is not in the cutting. The difference is in the reason for the surgery.

Do not choose a code based on what pays more. Choose based on the patient’s surgical history. If the patient had a tubal ligation, use 58750. If she had a prior salpingectomy for an ectopic, use 58752.

Important note: Some payers consider all tubal reversal surgery as non-covered, regardless of the code. Always verify benefits before the procedure.

What About Unilateral Procedures?

Unilateral tubal reanastomosis is rare. Most surgeons will not open the abdomen to fix just one tube. If they are already inside, they fix both.

However, there are exceptions. For example:

• The patient has only one fallopian tube remaining (the other was removed years ago).

• The contralateral tube is absent due to a congenital issue.

• The other tube is irreparably damaged.

In these cases, you bill 58750 without a modifier. Do not add modifier 50. Do not add modifier LT or RT unless the payer specifically requires them. Most payers accept 58750 as unilateral by default.

The Role of Modifiers in Tubal Reanastomosis Coding

Modifiers are not exciting. But they save your claims. For tubal reanastomosis, you will use two modifiers most often.

Modifier 50 (Bilateral Procedure)

This is your best friend. Use it when the surgeon performs the same procedure on both the left and right fallopian tubes.

Example:
A patient with a prior laparoscopic clip ligation on both sides undergoes reversal. The surgeon reconnects both tubes.

• Correct code: 58750-50

Do not bill 58750 twice. Do not bill 58750 and 58750 again. Use one line with modifier 50.

Modifier 22 (Increased Procedural Services)

Sometimes, the surgery is not straightforward. There are dense adhesions. There is extensive endometriosis. The tubes are severely shortened. The case takes two or three times longer than usual.

In these situations, you can append modifier 22 to 58750 or 58752. This tells the payer: “This was more work than usual. Please pay extra.”

How to succeed with modifier 22:

• You must attach an operative report.

• You must write a cover letter explaining the unusual complexity.

• You must show the time difference (e.g., “Usual time: 90 minutes. Actual time: 210 minutes”).

Without strong documentation, modifier 22 will be ignored.

What CPT Codes Are Not Included?

Let us clear up common mistakes. Do not use these codes for tubal reanastomosis.

Stick with 58750 and 58752. Only go to unlisted codes if the surgeon does something truly unusual, like reimplanting the tube into the uterus (tubouterine implantation).

Laparoscopic vs. Mini-Laparotomy: Does the Code Change?

Here is a surprise. The CPT code does not change based on the surgical approach.

Whether the surgeon uses:

• A traditional open mini-laparotomy (small incision in the bikini line)

• A robotic-assisted approach

• A laparoscopic approach (rare for reversal, but possible)

The code remains 58750 or 58752.

Why? Because the work is defined by the anatomy, not the incision. The surgeon still must identify, trim, and reconnect the tubal ends. That is the same task with a scope or an open incision.

However, there is a practical difference. Most payers do not separately reimburse for the laparoscopy itself. The global package of 58750 includes the approach. You cannot add a separate laparoscopy code like 49320.

Documentation Requirements for Successful Reimbursement

Your coding is only as good as your documentation. The surgeon must write a clear operative note. You, as the coder, need specific elements to justify the CPT code.

Required Elements in the Operative Note

Here is what you should look for:

1. History of prior sterilization – Mention of tubal ligation, clips, rings, or cautery.

2. Laterality – Explicit statement of “right tube,” “left tube,” or “bilateral.”

3. Description of the anastomosis – Words like “reapproximation,” “reanastomosis,” “microsuture,” or “end-to-end.”

4. Condition of the tubes – Healthy segments, length remaining, presence of adhesions.

5. Chromotubation – Confirmation that dye passed through the reconstructed tube.

If the operative note is missing any of these, ask for an addendum. Do not guess.

Example of Strong Documentation

*”The patient had a prior laparoscopic tubal ligation with Filshie clips. Both clips were removed. The right tube was transected with a 2cm damaged segment excised. The healthy proximal and distal ends were reapproximated over a stent using 8-0 nylon sutures. Chromotubation showed free spillage bilaterally. Left tube underwent identical repair.”*

This note supports 58750-50 perfectly.

Global Period and Follow-Up Care

Tubal reanastomosis has a 90-day global period. That means the following services are included in the reimbursement. You cannot bill separately for:

• Post-operative visits in the hospital

• Office visits within 90 days related to the surgery

• Removal of sutures

• Routine wound checks

• Uncomplicated recovery management

You can bill separately for:

• Visits for unrelated problems (e.g., a urinary tract infection)

• Visits after the 90-day global period

• A new problem, such as a hernia at the incision site

Keep a calendar. Track the date of surgery. Do not bill for E/M services too early.

Common Denial Reasons and How to Fix Them

Even experienced coders get denials. Here are the top reasons payers reject tubal reanastomosis claims.

Denial 1: “Procedure is not medically necessary”

This is the most common denial. Many insurance plans explicitly exclude reversal of sterilization. They view it as elective.

How to fight it:
Check the patient’s plan documents before surgery. Look for the “Sterilization Reversal Exclusion.” If it exists, you cannot win. The patient must pay out-of-pocket.

If there is no exclusion, submit a medical necessity letter. Explain the patient’s psychological distress, change in marital status, or loss of a child. Some payers require a mental health evaluation.

Denial 2: “Missing modifier 50”

You billed 58750 once without a modifier. The payer paid for one tube only.

How to fix it:
Resubmit the claim with 58750-50. If you cannot resubmit, appeal with a copy of the operative note showing bilateral repair.

Denial 3: “Code bundled with primary procedure”

This happens if you bill 58750 with another major procedure on the same day, such as a hysterectomy. Some payers consider the reversal incidental.

How to fix it:
Appeal with documentation that the reversal was a separate, planned, and distinct procedure. Use modifier 59 (Distinct Procedural Service) if appropriate, though this is rare.

How Much Does Tubal Reanastomosis Reimburse?

Let us talk numbers. But remember: reimbursement varies wildly by payer, region, and contract.

As a rough guide for 2026:

• Medicare (very rare, only if medically necessary): Approximately $900 – $1,200 for 58750-50

• Commercial insurance (in-network): Approximately $2,500 – $5,000 for 58750-50

• Out-of-pocket cash price (self-pay): $5,000 – $12,000 including facility and anesthesia

Do not quote these numbers to patients without checking your specific payer fee schedule. Use your contracted rates.

Facility vs. Non-Facility Pricing

CPT 58750 is typically performed in a hospital outpatient department or an ambulatory surgery center (ASC). The facility bills separately for the room, supplies, and nursing time.

As the professional coder, you bill for the surgeon’s work only. The facility bills with their own codes (often unlisted or ASC-specific codes).

Bundled Services You Cannot Bill Separately

I mentioned this earlier, but it deserves its own section. Many coders try to add extra codes to increase revenue. Do not do this. You will trigger audits.

Do NOT bill these codes with 58750:

The only exception is if the lysis of adhesions is extensive and performed on completely different organs. For example, if the surgeon frees the liver or the bowel in a separate area, you might bill 44005 with modifier 59. But this is extremely rare.

Tubal Reanastomosis and Infertility Diagnosis Codes

The CPT code is only half the claim. You also need an ICD-10-CM diagnosis code. The diagnosis code must support the medical necessity of the procedure.

Primary Diagnosis Codes

Use these codes as your first-listed diagnosis:

• Z31.42 – Encounter for sterilization reversal. This is the most accurate code for a patient who simply wants to become pregnant again after ligation.

• N97.8 – Female infertility of other origin. Use this if the patient has been trying to conceive without success, even if she also wants reversal.

• Z98.51 – Tubal ligation status. Use this as a secondary code to indicate the prior procedure.

Do Not Use These Diagnosis Codes

Avoid these unless the patient truly has the condition:

• N97.1 – Infertility of tubal origin. This implies the tube is blocked from disease, not from elective ligation. Using this incorrectly is fraud.

• Z33.1 – Pregnant state, incidental. The patient cannot be pregnant at the time of reversal.

Example of a Correct Claim

CPT: 58750-50
ICD-10-CM: Z31.42, Z98.51
Reason for visit: Patient desires reversal of prior bilateral tubal ligation to attempt natural conception.

This is clean, honest, and defensible.

Special Situations in Tubal Reanastomosis Coding

Real life is messy. Patients do not always read the textbook. Here are some tricky scenarios and how to code them.

Scenario 1: One Tube Reversed, One Tube Removed

The surgeon finds that the right tube is healthy and reconnects it. The left tube is too damaged to save, so the surgeon removes it (salpingectomy).

What do you bill?

• 58750 (unilateral, no modifier) for the reversal on the right.

• 58700 (salpingectomy) for the removal on the left.

Append modifier 59 to 58700 to show it is a distinct procedure.

Scenario 2: Prior Unilateral Salpingectomy, Now Reversing the Remaining Tube

The patient had her left tube removed for an ectopic pregnancy years ago. Now she wants to reverse her right tube, which was previously ligated.

What do you bill?

• 58750 (unilateral) – because only one tube is being reversed.

Do not use modifier 50. There is no bilateral procedure.

Scenario 3: Surgeon Converts to Salpingectomy Midway

The surgeon starts a reversal. But the tubal segments are too short (less than 4cm total length). Reconstruction is impossible. The surgeon closes the abdomen without performing the anastomosis.

What do you bill?

• 58999 (Unlisted procedure) – because no anastomosis was performed.

• Submit the operative note and request a fair payment based on time and complexity.

Do not bill 58750. The key action (reconnection) did not happen.

Insurance Coverage and Patient Financial Responsibility

This is a sensitive topic. Tubal reanastomosis is often not covered. You must have a honest conversation with the patient before scheduling the surgery.

Ask These Three Questions Before Booking

1. Does the patient’s plan have a sterilization reversal exclusion?

2. Has the patient met her deductible and out-of-pocket maximum?

3. Does the plan require pre-authorization?

If the answer to #1 is “yes,” the patient will pay 100% out-of-pocket. Do not bill the insurance. Collect payment upfront.

Sample Financial Consent Language

“I understand that tubal reanastomosis is often considered an elective procedure. My insurance plan may deny coverage. If denied, I am financially responsible for all charges, including surgeon, facility, and anesthesia fees.”

Get this signed. Keep it in the chart.

Tips for Reducing Denials on Tubal Reanastomosis Claims

You want clean claims. Here is a checklist to run before you submit.

• Did you verify the patient’s plan does not explicitly exclude sterilization reversal?

• Did you obtain prior authorization in writing?

• Is the correct CPT code (58750 or 58752) based on the operative note?

• Did you append modifier 50 for bilateral cases?

• Is the diagnosis code Z31.42 (or appropriate) listed first?

• Is the operative note available and complete?

• Did you avoid billing bundled services?

If you can answer “yes” to all seven, submit with confidence.

The Future of Tubal Reanastomosis Coding

Will CPT codes change? Possibly. The American Medical Association (AMA) updates the CPT manual every year. However, 58750 has been stable for decades. It is unlikely to disappear soon.

What is changing is how often surgeons perform the procedure. More patients are choosing IVF over surgery. That means fewer reversals. But for the patients who do choose reversal, the coding remains the same.

Stay updated by:

• Reading the CPT manual each year.

• Joining a local AAPC (American Academy of Professional Coders) chapter.

• Following CMS transmittals for telehealth and surgery rules.

Frequently Asked Questions (FAQ)

1. Is CPT 58750 the same for robotic-assisted tubal reversal?

Yes. The code does not change for robotic assistance. Do not add a separate robotic code.

2. Can I bill 58750 twice if the surgeon works on both tubes?

No. Use modifier 50 on a single line. Billing two lines is incorrect and will be denied.

3. What if the surgeon also removes scar tissue from the ovaries?

If the adhesiolysis is minimal and part of accessing the tubes, it is included. If it is extensive and separate, you may bill 58660 with modifier 59. But this is rare.

4. Does Medicare cover tubal reanastomosis?

Almost never. Medicare considers reversal of sterilization not reasonable and necessary unless the prior ligation was performed for a medical reason (e.g., to prevent pregnancy that would endanger the patient’s life). Even then, it is difficult to obtain coverage.

5. What is the difference between 58750 and 58752 in plain English?

58750 is for reversing a tubal ligation. 58752 is for repairing a tube damaged by disease or prior ectopic pregnancy.

6. How long is the global period for 58750?

90 days. All routine post-op care is included.

7. Can the patient bill her own insurance for the reversal?

No. The provider must bill. The patient cannot submit a professional claim on her own behalf.

8. What anesthesia codes are used with tubal reanastomosis?

Anesthesia is billed separately by the anesthesiologist. The typical code is 00851 (anesthesia for intraperitoneal procedures in lower abdomen). Do not include anesthesia in your surgical claim.

Additional Resources

For further reading and official guidance, consult the American College of Obstetricians and Gynecologists (ACOG) practice bulletin on tubal reversal. You can also review the current CPT manual directly from the AMA.

Link: American College of Obstetricians and Gynecologists – Tubal Reversal (opens external site)

Note: Always verify codes with your local payer and the current year’s CPT manual. Coding guidelines change. This article reflects best practices as of April 2026.

Conclusion

Tubal reanastomosis coding centers on two main codes: 58750 for reversal of sterilization and 58752 for repair after disease. Most cases require modifier 50 for bilateral work. Documentation must clearly state the history, laterality, and surgical technique. Always verify insurance coverage before the procedure, as many plans exclude reversal. Use Z31.42 as your primary diagnosis code, and never bill bundled services separately.

Disclaimer: This article is for educational purposes only. It does not constitute legal or medical advice. Coding and reimbursement rules vary by payer and jurisdiction. Always consult the current CPT manual and your compliance officer before submitting claims.