Does Anthem require prior authorization for CPT 58571?

Yes. Anthem requires prior authorization for CPT 58571 (Abdominal and laparoscopic hysterectomy) under Standard commercial plans per its published clinical policy.

What documentation does Anthem require for CPT 58571?

Clinical notes; Pelvic imaging; Failed treatment documentation; Biopsy results if applicable

How much does Medicare pay for CPT 58571 in 2026?

In 2026, the national Medicare allowable for CPT 58571 is $828.68 in an office setting and $828.68 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.

What if Anthem denies the PA for CPT 58571?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Anthem Prior Authorization for CPT 58571

Abdominal and laparoscopic hysterectomy · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified January 1, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Anthem clinical policy

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

Clinical criteria

Anthem requires prior authorization for laparoscopic hysterectomy. Medically necessary for symptomatic uterine fibroids unresponsive to medical therapy, abnormal uterine bleeding with failed hormonal management, severe endometriosis, and gynecologic malignancy. Alternatives to hysterectomy should be documented as considered.

Documentation checklist

✓Clinical notes
✓Pelvic imaging
✓Failed treatment documentation
✓Biopsy results if applicable

Submission channels

Phone

1-800-274-7767

2026 Medicare rate for CPT 58571

Office (non-facility)

$828.68

Facility

$828.68

Total RVUs (office)

24.81

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Anthem's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 58571 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Clinical notes, Pelvic imaging, Failed treatment documentation….
3Submit via phone, or the payer portal.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Anthem require prior authorization for CPT 58571?: Yes. Anthem requires prior authorization for CPT 58571 (Abdominal and laparoscopic hysterectomy) under Standard commercial plans per its published clinical policy.
What documentation does Anthem require for CPT 58571?: Clinical notes; Pelvic imaging; Failed treatment documentation; Biopsy results if applicable
How much does Medicare pay for CPT 58571 in 2026?: In 2026, the national Medicare allowable for CPT 58571 is $828.68 in an office setting and $828.68 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.
What if Anthem denies the PA for CPT 58571?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Other Anthem PA lookups

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CPT 58571 prior authorization by payer

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