Summary & Overview
CPT 57130: Removal of Vaginal Tissue Flap
CPT code 57130 denotes a vaginal surgical procedure in which a physician excises a tissue flap that is dividing the vaginal canal. This gynecologic operation is clinically significant for treating structural vaginal abnormalities that can cause functional impairment, pain, or recurrent infections. Nationally, accurate coding for this procedure affects surgical case mix, quality measurement, and appropriate reimbursement for hospital outpatient departments and ambulatory surgery centers.
Key payers addressed in this analysis 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 scope of services represented by this code. The publication summarizes common billing modifiers provided in the input and highlights areas where payers often apply coverage policies or prior authorization requirements.
This summary equips billing professionals, practice administrators, and policy analysts with a clear definition of the service represented by CPT code 57130, its relevance to gynecologic surgical workflows, and the types of payer considerations that commonly accompany surgical billing. Data not available in the input for specific ICD-10 mappings or payer-specific fee benchmarks is noted where applicable.
Billing Code Overview
CPT code 57130 describes a surgical procedure in which a physician removes a flap of tissue that is dividing the vaginal canal. This operation is performed via a vaginal approach and is primarily a gynecologic surgical procedure.
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Service type: Vaginal reconstructive/ablative surgery
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Typical site of service: Hospital outpatient department or ambulatory surgery center (vaginal surgical setting)
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a reproductive-age or postmenopausal woman who presents with symptoms of dyspareunia, recurrent urinary tract symptoms, obstructed intercourse, or difficulty with vaginal hygiene due to a persistent transverse vaginal septum or prominent vaginal mucosal fold. Evaluation includes history, pelvic examination, and, when indicated, pelvic ultrasound to define the location and thickness of the septum or flap. After counseling, the patient is scheduled for a transvaginal excision under regional or general anesthesia in an ambulatory surgical center or hospital outpatient department. The procedure involves removal of the obstructing mucosal flap or septum via a vaginal approach, hemostasis, and layered closure as needed. Postoperative workflow includes recovery-room monitoring, short course analgesia, activity restrictions, wound care instructions, and follow-up visit within 1–4 weeks to assess healing and sexual function. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed and documented as distinct from the operative procedure on the same day |
22 |