CPT 57135 Vaginal Wall Excision Reimbursement | OpenPayer

Summary & Overview

CPT 57135: Excision of Vaginal Wall Cyst or Tumor

CPT code 57135 denotes surgical excision of a cyst or tumor located in the vaginal wall via a vaginal approach. This procedure is a targeted gynecologic surgical service frequently performed in ambulatory surgery centers or hospital operating rooms and is relevant to gynecologic surgeons, surgical coders, and payers managing outpatient and inpatient procedural claims. Nationally, accurate coding for 57135 affects claims adjudication, resource allocation, and quality measurement for gynecologic surgical care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of clinical context, typical sites of service, common billing considerations, and where to expect policy and payment variability across major payers. The publication outlines benchmark metrics and payment policy updates where available and highlights common coding and claim-line considerations for surgical excision of vaginal wall lesions. Clinical context includes indications for excision of cysts and benign or malignant tumors when approached vaginally, perioperative setting considerations, and how the service maps to procedure-based surgical workflows.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and payer-specific rates is noted where appropriate.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare57135CPTvaginal-surgerygynecologic-surgerysurgical-excisionambulatory-surgeryoperative-coding

Billing Code Overview

CPT code 57135 describes a surgical procedure to remove a cyst or tumor from the vaginal wall using a vaginal approach. Service type: surgical excision of vaginal wall lesion. Typical site of service: inpatient or outpatient hospital operating room or ambulatory surgery center with a vaginal route of access.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 38-year-old woman presents with a month-long history of a painless bulge and occasional vaginal discomfort. Pelvic examination identifies a 2.5 cm, well-circumscribed, submucosal mass in the anterior vaginal wall consistent with a Gartner duct cyst. Transvaginal ultrasound confirms a cystic lesion without evidence of deeper pelvic organ involvement. The patient elects definitive removal due to persistent symptoms and concern for growth. The clinical workflow includes preoperative evaluation (history, focused pelvic exam, pregnancy test, and informed consent), pre-op anesthesia assessment (local with sedation or regional/general anesthesia), sterile vaginal surgical approach with excision of the cyst/tumor from the vaginal wall, brief intraoperative hemostasis and inspection, specimen submission to pathology, and post-anesthesia recovery with discharge instructions and wound care. Typical perioperative documentation includes indication, lesion size and location, surgical technique (vaginal approach), estimated blood loss, complications (if any), specimen sent to pathology, and postoperative follow-up plan.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical for the procedure (document specifics).
`23`

CPT 57109: Upper Vaginectomy with Pelvic and Para‑aortic Lymph Node Biopsy

CPT-57130-VAGINAL-TISSUE-FLAP-REMOVAL

CPT 57130: Removal of Vaginal Tissue Flap

CPT-57106-PARTIAL-VAGINECTOMY-UPPER-OR-LOWER-RESECTION

CPT 57106: Partial Vaginectomy, Upper One-Third or Lower Two-Thirds

CPT-57107-PARTIAL-VAGINECTOMY-PARAVAGINAL-TISSUE-RESECTION

CPT 57107: Partial Vaginectomy with Paravaginal Tissue Resection

CPT-57110-VAGINECTOMY-COMPLETE-VAGINAL-WALL-REMOVAL

CPT 57110: Complete Removal of Vaginal Wall

CPT-57105-VAGINAL-LESION-BIOPSY-LARGE-LESION

CPT 57105: Evaluation and Biopsy of Large Vaginal Lesion

CPT-57100-VAGINAL-MUCOSAL-LESION-BIOPSY

CPT 57100: Biopsy of Lesion on Vaginal Mucosa

CPT-57111-VAGINECTOMY-WITH-PARAVAGINAL-TISSUE-REMOVAL

CPT 57111: Vaginectomy with Paravaginal Tissue Removal

CPT-57120-VAGINAL-CLOSURE-FOR-PROLAPSE

CPT 57120: Vaginal Closure for Vaginal Prolapse

Taxonomy Code	Specialty	Notes
`207V00000X`	Obstetrics & Gynecology	Most common specialty performing vaginal wall cyst/tumor excision.
`208600000X`	General Surgery	May perform excision for perivaginal masses depending on practice and referral patterns.
`363L00000X`	Gynecologic Oncology	May be involved when there is concern for neoplastic disease requiring oncologic evaluation.
`208800000X`	Urology	May participate for lesions that impinge on lower urinary tract or in multidisciplinary care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N76.0`	Acute vaginitis	Inflammation or infection that may coincide with or complicate vaginal wall lesions; may be assessed prior to excision.
`N76.1`	Subacute and chronic vaginitis	Chronic inflammatory conditions that can mimic or coexist with vaginal masses.
`N89.8`	Other specified noninflammatory disorders of vagina	Used for assorted benign vaginal lesions when a more specific code is not appropriate.
`N90.89`	Other atrophic disorders of vulva and vagina	Relevant when atrophic changes contribute to mucosal cyst formation or symptomatic presentation.
`D25.9`	Leiomyoma of uterus, unspecified	Included when uterine fibroids present concurrently but not primary to vaginal wall excision; listed for context when pelvic surgery is coordinated.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57135`	Excision of vaginal cyst or tumor, vaginal approach	Primary procedure: surgical removal of cyst or tumor from the vaginal wall.
`56820`	Biopsy of vulva; single lesion	Performed if suspicious vulvar lesion requires biopsy in the same encounter or prior evaluation.
`57061`	Biopsy, other vaginal lesion	Performed when a diagnostic biopsy of a vaginal lesion is done before definitive excision.
`57460`	Colposcopy of the cervix, with biopsy(s) of the cervix; without endocervical curettage	May be performed in the same episode if concurrent cervical evaluation is indicated.
`99024`	Postoperative follow-up visit global period	Represents routine postoperative follow-up during the global period after a surgical procedure.

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