Medicare Benefits Schedule - Note TN.8.231

Procedure may be undertaken using laparoscopy with any number of ports or by any approach as clinically indicated.

A laparoscopically assisted vaginal hysterectomy is defined as the introduction of the laparoscope to assess the pelvis and commence the procedure taking the round ligaments, adnexal attachments as indicated and to the level of the uterine arteries with the uterine arteries and uterosacral pedicles secured vaginally. 

A total laparoscopic hysterectomy is defined as the introduction of the laparoscope to assess the pelvis and complete the procedure laparoscopically including securing the uterine arteries and uterosacral pedicles. 

The complex hysterectomy items 35753 and 35754 are intended to cover procedures with increased complexity. 35753 is to be used for the excision of moderate endometriosis. 35754 is to be used for the excision of extensive endometriosis and when side wall dissection is required.

Related Items: 35750 35751 35753 35754 35756

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Multiple Operation Rule

Hysterectomy, laparoscopic assisted vaginal, by any approach, including any endometrial sampling, with or without removal of the tubes or ovarian cystectomy or removal of the ovaries and tubes due to other pathology, not being a service associated with a service to which item 35595 or 35673 applies. (H)

(Anaes.) (Assist.)

Fee: $863.60 Benefit:

(See para TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, laparoscopic, by any approach, including any endometrial sampling, with or without removal of the tubes, not being a service associated with a service to which item 35595 applies (H) 

(Anaes.) (Assist.)

Fee: $863.60 Benefit: 75% = $647.70

(See para TN.8.2, TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, complex laparoscopic, by any approach, including endometrial sampling, with either or both of the following procedures:
(a) unilateral or bilateral salpingo-oophorectomy (excluding salpingectomy);
(b) excision of moderate endometriosis or ovarian cyst;
including any associated laparoscopy, not being a service associated with a service to which item 35595 applies (H) 

(Anaes.) (Assist.)

Fee: $954.95 Benefit: 75% = $716.25

(See para TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, complex laparoscopic, by any approach, that concurrently requires either extensive retroperitoneal dissection or complex side wall dissection, or both, with any of the following procedures (if performed):
(a) endometrial sampling;
(b) unilateral or bilateral salpingectomy, oophorectomy or salpingo-oophorectomy;
(c) excision of ovarian cyst;
(d) any other associated laparoscopy;
not being a service associated with a service to which item 35595 or 35641 applies (H)

(Anaes.) (Assist.)

Fee: $1,845.25 Benefit: 75% = $1,383.95

(See para TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, laparoscopic, by any approach, if the procedure is completed by open hysterectomy for control of bleeding or extensive pathology, including any associated laparoscopy, not being a service associated with a service to which item 35595 or 35641 applies (H) 

(Anaes.) (Assist.)

Fee: $1,575.00 Benefit: 75% = $1,181.25

(See para TN.8.229, TN.8.231 of explanatory notes to this Category)