Summary & Overview
CPT 57230: Repair of Urethrocele (Urethral Prolapse into Vagina)
CPT code 57230 denotes surgical repair of a urethrocele, a pelvic reconstructive procedure addressing urethral prolapse into the vagina. This code is relevant nationally because urethroceles are part of the spectrum of pelvic organ prolapse conditions that drive gynecologic surgical volume, affect patient quality of life, and intersect with coverage policies for pelvic reconstructive services. Payors commonly involved in coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of clinical intent and typical care settings for 57230, followed by benchmarks and payer policy context where available. The publication summarizes reimbursement benchmarks, coding and billing considerations, and clinical context for providers and revenue-cycle stakeholders. It also highlights common modifiers and coding relationships for downstream billing workflows. Where specific payer policies are not provided in the input, the publication notes that data is not available in the input.
This national-level summary is intended for health system revenue leaders, clinicians in urogynecology and gynecology, and payer policy analysts seeking a clear description of the service, expected sites of care, and which major payers are typically involved in coverage and claims processing for this type of pelvic reconstructive surgery.
Billing Code Overview
CPT code 57230 describes the surgical repair of a urethrocele, a condition in which the urethra prolapses into the vagina. The procedure is a gynecologic pelvic reconstructive surgery aimed at restoring normal urethral and vaginal support.
Service type: Surgical — pelvic reconstructive/urogynecologic repair
Typical site of service: Hospital operating room or ambulatory surgical center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old female presents to an outpatient gynecology clinic with progressive vaginal bulging and urinary leakage. She reports a sensation of pressure and observes tissue protruding from the vaginal introitus with coughing or straining. Past obstetric history includes multiple vaginal deliveries and chronic pelvic floor weakness. Physical exam demonstrates a urethrocele with anterior vaginal wall prolapse and associated stress urinary incontinence. After failed conservative management (pelvic floor physical therapy and pessary trial), the surgeon schedules a transvaginal urethrocele repair.
The clinical workflow includes preoperative evaluation (history, pelvic exam, urinalysis, and voiding assessment), informed consent, preoperative anesthesia evaluation, and scheduling in an ambulatory surgery center or hospital outpatient department. On the day of surgery the patient undergoes general or regional anesthesia. The gynecologic surgeon performs a transvaginal anterior repair of the urethral prolapse using layered vaginal wall closure and periurethral support sutures. Postoperative recovery includes short PACU observation, discharge with activity restrictions and pelvic floor precautions, and scheduled postoperative visits for wound check and continence assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the repair requires substantially greater work than typical (extensive dissection, fibrosis). |