CPT 45560 Rectocele Repair Reimbursement | OpenPayer

Summary & Overview

CPT 45560: Rectocele Repair (Vaginal)

CPT code 45560 covers surgical repair of a rectocele — correction of a forward protrusion of the rectum into the vagina. The procedure addresses pelvic organ support defects that can cause obstructed defecation, vaginal bulge, and pain, and is a common pelvic reconstructive surgery following vaginal childbirth. Nationally, this code is relevant to surgical specialists in urogynecology, colorectal surgery, and general gynecology and impacts hospital and ambulatory surgery utilization and reimbursement for pelvic floor reconstruction.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the operational considerations that affect coding and billing. The publication provides benchmarks and comparisons where available, explains common billing constructs associated with pelvic reconstructive procedures, and summarizes policy and coverage considerations that affect payment and utilization nationally. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45560CPTrectocele repairpelvic reconstructive surgeryurogynecologyambulatory surgeryhospital outpatientpelvic floorsurgical procedure

Billing Code Overview

CPT code 45560 describes a surgical repair of a rectocele, a forward protrusion of the rectum into the vagina. This procedure is performed to correct pelvic floor support defects that commonly arise after vaginal childbirth, particularly following delivery of a larger-than-average infant.

Service type: Surgical repair of pelvic floor defect (rectocele repair)
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 32-year-old multiparous woman presents with a symptomatic full-thickness rectocele (posterior vaginal wall prolapse) that developed after a prior vaginal delivery of a large-for-gestational-age infant. She reports vaginal bulge, difficulty with bowel evacuation and splinting, and pelvic pressure that worsens with Valsalva. Conservative measures including pelvic floor physical therapy and stool softeners failed. After evaluation by a urogynecologist with pelvic exam and defecatory assessment, the decision is made to perform a surgical repair (posterior colporrhaphy with rectovaginal septum repair) under regional or general anesthesia. Typical workflow: preoperative assessment and informed consent, anesthesia induction, operative repair of the rectocele via a transvaginal posterior colporrhaphy technique with plication and reinforcement of the rectovaginal septum, hemostasis and layered vaginal wall closure, postoperative monitoring in PACU, and routine postoperative follow-up for wound healing and bowel function recovery.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, and complexity substantially exceed usual for `45560` (document specifics).
`51`

CPT 45562: Exploratory Rectal Repair with Presacral Drainage

CPT-45500-ANORECTAL-STENOSIS-RELEASE-WITH-FLAP-REPAIR

CPT 45500: Release of Anorectal Stenosis with Flap Repair

CPT-45505-RECTAL-MUCOSA-EXCISION-AND-FLAP-REPAIR

CPT 45505: Excision of Prolapsed Rectal Mucosa with Flap Repair

CPT-45825-RECTOURETHRAL-FISTULA-CLOSURE-WITH-SIGMOID-COLOSTOMY

CPT 45825: Rectourethral Fistula Closure with Sigmoid Colostomy

CPT-45805-RECTOVESICAL-FISTULA-REPAIR-WITH-SIGMOID-COLOSTOMY

CPT 45805: Rectovesical Fistula Repair with Sigmoid Colostomy

CPT-45563-RECTAL-INJURY-REPAIR-SIGMOID-COLOSTOMY

CPT 45563: Rectal Injury Repair with Sigmoid Colostomy

CPT-45820-RECTOURETHRAL-FISTULA-REPAIR-ABDOMINAL-APPROACH

CPT 45820: Abdominal Repair of Rectourethral Fistula

CPT-45541-PERINEAL-RECTAL-PROLAPSE-REPAIR-MESH-SUTURES

CPT 45541: Perineal Rectal Prolapse Repair with Mesh and Sutures

CPT-45540-ABDOMINAL-RECTOPEXY-RECTAL-PROLAPSE-MESH-SUTURE

CPT 45540: Abdominal Rectopexy for Rectal Prolapse

CPT-45800-RECTOVESICAL-FISTULA-REPAIR-OPEN-ABDOMINAL

CPT 45800: Open Abdominal Repair of Rectovesical Fistula

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Taxonomy Code	Specialty	Notes
207V00000X	Female Pelvic Medicine & Reconstructive Surgery	Specialists who commonly perform complex pelvic floor and rectocele repairs.
207K00000X	Obstetrics & Gynecology	General gynecologists perform transvaginal pelvic reconstructive surgeries including rectocele repair.
207T00000X	Colon & Rectal Surgery	Colorectal surgeons may participate when bowel involvement or complex defect is present.
208000000X	Urology	Urogynecologic collaboration for multi-compartment pelvic floor repairs (selected cases).
1835P0800X	Nurse Practitioner	Advanced practice providers involved in pre- and postoperative care and follow-up (not primary surgeon).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N81.3`	Rectocele	Primary diagnosis for which `45560` is performed; describes posterior vaginal wall prolapse due to rectal protrusion.
`N81.4`	Uterovaginal prolapse, unspecified	Frequently coexists; may alter surgical planning when multi-compartment prolapse present.
`K59.3`	Slow transit constipation	Symptom-related diagnosis that may accompany rectocele and be an indication for repair when obstructive defecation occurs.
`K64.8`	Other hemorrhoids	May be present concurrently and assessed during evaluation of posterior compartment symptoms.
`N99.89`	Other postprocedural states and complications of genitourinary system, not elsewhere classified	Used when documenting postoperative complications related to pelvic reconstructive surgery if applicable.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57240`	Repair of enterocele, vaginal approach, any technique	Performed when apical or enterocele defects coexist with rectocele and require repair during same session.
`57250`	Colpopexy, abdominal approach; extra-peritoneal (includes sacrospinous or uterosacral fixation)	Often performed when concurrent vault prolapse requires suspension in addition to posterior repair.
`57420`	Colposcopy of the cervix including biopsy, single or multiple; with/without endocervical sampling	May be performed preoperatively for screening or evaluation when indicated.
`51990`	Repair of vaginal fistula (vesicovaginal, enterovaginal)	Used if an unexpected rectovaginal fistula is identified and repaired during the procedure.
`99024`	Postoperative follow-up visit global period related	Represents routine postoperative global period follow-up visits related to the surgical repair.

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