CPT 58542
Global 090 ActiveLsh w/t/o ut 250 g or less
CPT 58542 Billing & Documentation Guide
CPT code 58542 (Lsh w/t/o ut 250 g or less) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 13.81, a non-facility practice expense RVU of 5.79, and a malpractice RVU of 2.36, a total non-facility RVU of 21.96 and facility RVU of 21.96. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $740, though rates vary from $667.98 to $941.29 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 58542, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 58542 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 58542 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 58542
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 13.81 | 13.81 |
| Practice Expense RVU | 5.79 | 5.79 |
| Malpractice RVU | 2.36 | 2.36 |
| Total RVU | 21.96 | 21.96 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 58542
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $749.38 | $749.38 | $723.32 - $833.13 | 29 |
| Florida | $808.75 | $808.75 | $764.62 - $861.94 | 3 |
| Georgia | $740.77 | $740.77 | $727.73 - $753.81 | 2 |
| Illinois | $800.38 | $800.38 | $761.04 - $839.76 | 4 |
| Michigan | $753.81 | $753.81 | $726.83 - $780.79 | 2 |
| North Carolina | $692.07 | $692.07 | $692.07 - $692.07 | 1 |
| New York | $806.05 | $806.05 | $700.4 - $867.11 | 5 |
| Ohio | $717.29 | $717.29 | $717.29 - $717.29 | 1 |
| Pennsylvania | $739.11 | $739.11 | $713.29 - $764.93 | 2 |
| Texas | $727.42 | $727.42 | $710.48 - $765.46 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 58542
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 58542 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0666T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 58542
What does CPT code 58542 mean? +
CPT code 58542 represents: Lsh w/t/o ut 250 g or less. It's in the Surgery (Urinary/Reproductive) category with a global period of 090.
What is the Medicare reimbursement for CPT 58542? +
The 2026 Medicare national average non-facility payment for CPT 58542 is $740. Rates range from $667.98 to $941.29 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 58542? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 58542? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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