I Was Told CPT 58661 is Not a Preventive Code

It should be easy to get birth control and other important health needs at no cost to you. But sometimes it’s not so easy. If you’re still paying out-of-pocket for your birth control and other health care, use our information below to start getting help.

Step 1: Find out if the health care law has kicked in for your health insurance plan.

Step 2: Still not sure? Here’s how to ask your health insurance company.

Step 3: Use the instructions and template letter below to appeal to your health insurance company if they are incorrectly charging you out-of-pocket costs when they shouldn’t.

We often see insurance companies denying full coverage of bilateral salpingectomies on the basis that the billing code used by the provider is not a preventative code. The CPT-code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/ or salpingectomy)) and ICD-10 code Z30.2 (Encounter for sterilization are the appropriate codes for the bilateral salpingectomy) are the appropriate preventive codes for a bilateral salpingectomy.

We often see these procedures coded correctly but still denied by insurance, who claim 58661 is not a preventative code. This is incorrect, as 58661 is a preventive code. A helpful coding guide can be found here (relevant pages 23-25).

• Find out where to send your letter: Call your plan, or if you have an appeal form, the address will be on it.
• Fill out the letter (templates are below): Replace all of the words in capital letters with your information. For example, replace “YOUR NAME” with your full name, and “POLICY NUMBER” with your plan policy number.
• Send copies of these documents with your letter: 
  • Records of any money you’ve paid for your birth control, such as receipts from the pharmacy.
  • A copy of the FDA’s “Birth Control Guide.”
  • After you send your letter to your health plan:
    • Make a copy of your letter and keep it in your files.
    • Share your letter and appeal form (if your plan is through your job).
      • You can send a copy to your plan’s “Plan Administrator.” Look at the information you received when you got your plan (this could be called your “Evidence of Coverage” or “Certificate of Coverage” or if you get your insurance through your work, “Summary Plan Description”) to find where to send this.
      • You can give a copy to your Human Resources department or contact.
    • Keep copies of receipts or other records that show what you pay for your birth control.
• Please let us know if your health plan responds—we are tracking decisions so we can advocate with both health insurance and government officials.

If you have any questions, contact us at 1-866-745-5487 or [email protected] for free help.

Document(s): 

• Sample Letter (Bilateral Salpingectomy – Billing code issue) – .docx
• Sample Letter (Bilateral Salpingectomy – Billing code issue) – .pdf

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