Summary & Overview
CPT 57160: Pessary Fitting and Insertion for Vaginal Wall Prolapse
CPT code 57160 covers the fitting and insertion of a pessary or similar intravaginal device to manage vaginal wall prolapse and related support disorders. This outpatient procedure is a common conservative treatment option that can reduce symptoms, delay surgery, or provide a non-surgical management pathway for pelvic organ prolapse. Nationally, attention to pessary management matters for access to conservative care, patient quality of life, and outpatient procedural billing consistency.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose and service context for CPT code 57160, plus benchmarking and policy-oriented content where available. The publication outlines reimbursement benchmarks, common billing practices, and documentation considerations relevant to payers and providers.
The piece also situates CPT code 57160 in clinical context—who receives pessaries and where the service is typically delivered—while noting gaps where input data is not provided. The goal is to give payers, billing professionals, and clinical leaders a clear, actionable understanding of the code’s role in non-surgical management of pelvic organ prolapse.
Billing Code Overview
CPT code 57160 describes the fitting and insertion of a pessary or similar intravaginal device to treat vaginal wall prolapse or other vaginal support disorders. This procedure involves selecting an appropriate pessary, fitting it to the patient's anatomy, and inserting it into the vaginal canal for therapeutic support.
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Service type: Device fitting and insertion procedure for pelvic organ support
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Typical site of service: Outpatient clinic or office-based gynecology practice; may also be performed in ambulatory surgery centers when performed in conjunction with other procedures or based on patient needs
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a postmenopausal woman presenting to a gynecology clinic with symptomatic pelvic organ prolapse (commonly anterior or posterior vaginal wall prolapse or uterine prolapse), urinary urgency or incontinence exacerbated by pelvic descent, or vaginal pressure and discomfort. After history, pelvic examination, and counseling regarding non-surgical options, the clinician selects a pessary trial. The procedure involves fitting an appropriate pessary device (ring, Gellhorn, cube, donut, or other) during an office visit, providing patient education on insertion/removal and hygiene, and arranging follow-up for device adjustment and monitoring. The procedure is performed in an outpatient clinic or office setting; typical workflow includes informed consent, pelvic exam, device fitting and insertion, teaching, and documentation of device type, size, patient tolerance, and plan for follow-up or referral for surgical management if pessary therapy fails.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of the procedure | Use when a distinct E/M visit is provided on the same day as the pessary fitting (e.g., complex counseling or diagnosis workup) |
50 |