CPT 57250 Posterior Vaginal Wall Repair Reimbursement | OpenPayer

Summary & Overview

CPT 57250: Posterior Vaginal Wall Repair (Rectocele) with Perineal Repair

CPT code 57250 represents surgical repair of a posterior vaginal wall defect (rectocele repair), often combined with perineal repair to restore pelvic floor support. This pelvic reconstructive procedure is performed to correct symptomatic rectal bulging into the vaginal canal and to improve pelvic floor function and quality of life. Nationally, the code is relevant to surgical practices in gynecology and urogynecology, ambulatory surgery centers, and hospital operating rooms where reconstructive pelvic procedures are performed.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find an overview of clinical context for 57250, common service settings, and the types of benchmarks and policy considerations typically examined for this code. The publication covers reimbursement benchmarks, utilization patterns, coding and billing considerations, and any recent policy updates affecting coverage and prior authorization trends. Clinical context explains the indications for repair and expected perioperative setting, while the billing-focused sections address documentation elements and payer variations that influence reimbursement. Data not available in the input will be identified explicitly in relevant sections rather than inferred.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare57250CPTpelvic-reconstructive-surgeryrectocele-repairurogynecologyambulatory-surgeryvaginal-wall-repair

Billing Code Overview

CPT code 57250 describes a surgical repair of a posterior vaginal wall defect where the rectum is protruding into the vaginal canal (rectocele repair). The procedure typically includes repair and reinforcement of the perineum below the vaginal opening.

Service type: Pelvic reconstructive surgery addressing posterior vaginal wall and perineal support
Typical site of service: Operative setting such as an ambulatory surgery center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is a woman in her 50s–70s presenting with a sensation of rectal bulge through the vagina, fecal incontinence or difficulty with bowel movements, and vaginal pressure. Examination confirms posterior vaginal wall defect consistent with rectocele, often accompanied by perineal descent or a weakened perineal body. Conservative measures (pelvic floor physical therapy, stool softeners) have failed or symptoms significantly impair quality of life. The clinical workflow includes preoperative evaluation with history, pelvic exam, possible defecography or dynamic pelvic MRI when indicated, bowel regimen optimization, informed consent discussing risks (bleeding, infection, dyspareunia, recurrence), and scheduling for an operative repair.

On the day of service the patient presents to an ambulatory surgical center or hospital operating room after appropriate preoperative clearance. Under regional or general anesthesia, the surgeon performs posterior colporrhaphy with dissection of the rectovaginal septum, plication/repair of the posterior vaginal wall, and reinforcement of the perineal body as indicated. Intraoperative steps include hemostasis, layered closure, and consideration of concomitant procedures if indicated. Postoperative care includes pain control, stool softeners, activity restrictions, and follow-up to assess wound healing and symptom improvement.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service

CPT 57268: Vaginal Repair for Small Bowel Prolapse

CPT-57295-VAGINAL-GRAFT-REVISION-REMOVAL

CPT 57295: Revision or Removal of Prosthetic Vaginal Graft

CPT-57330-VESICOVAGINAL-FISTULA-REPAIR-ABDOMINAL-AND-VAGINAL-APPROACH

CPT 57330: Vesicovaginal Fistula Repair, Combined Abdominal and Vaginal Approach

CPT-57265-VAGINAL-REPAIR-PELVIC-ORGAN-PROLAPSE-ENTEROCELE

CPT 57265: Vaginal Repair of Pelvic Organ Prolapse with Enterocele

CPT-57210-VAGINAL-PERINEAL-LACERATION-REPAIR-NONOBSTETRIC

CPT 57210: Repair of Vaginal Wall or Perineal Laceration, Nonobstetric

CPT-57308-RECTOVAGINAL-FISTULA-REPAIR-PERINEAL-APPROACH

CPT 57308: Rectovaginal Fistula Repair via Perineal Approach

CPT-57311-URETHROVAGINAL-FISTULA-REPAIR-BULBOCAVERNOSUS-FLAP

CPT 57311: Urethrovaginal Fistula Repair with Bulbocavernosus Muscle Flap

CPT-57292-VAGINOPLASTY-WITH-GRAFT-CONSTRUCTION-ARTIFICIAL-VAGINA

CPT 57292: Vaginoplasty with Graft, Construction of Artificial Vagina

CPT-57320-VAGINAL-REPAIR-VESICOVAGINAL-FISTULA

CPT 57320: Vaginal Repair of Vesicovaginal Fistula

CPT-57307-ABDOMINAL-EXCISION-RECTOVAGINAL-FISTULA-WITH-COLOSTOMY

CPT 57307: Excision of Rectovaginal Fistula with Colostomy Creation

Showing 1–10 of 31

Taxonomy Code	Specialty	Notes
207V00000X	Obstetrics & Gynecology	Most common specialty performing posterior colporrhaphy and perineorrhaphy.
206E00000X	Female Pelvic Medicine & Reconstructive Surgery	Subspecialists managing complex pelvic floor defecatory disorders and advanced repairs.
2080P0206X	Colon & Rectal Surgery	Involved when concomitant rectal pathology or complex rectocele requiring colorectal input is present.
363A00000X	Urogynecology (if distinct taxonomy used)	Focused expertise in pelvic organ prolapse repairs and pelvic floor reconstruction.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.89`	Other specified diseases of anus and rectum	Can capture nonspecific rectal support defects contributing to rectocele symptoms.
`N81.3`	Rectocele	Direct diagnosis indicating posterior vaginal wall prolapse; primary indication for posterior colporrhaphy.
`N81.4`	Uterovaginal prolapse, unspecified	May coexist with posterior compartment defects and influence surgical planning.
`N81.6`	Enterocele	Small-bowel herniation into the posterior vaginal canal often addressed during posterior repair.
`R15.9`	Full incontinence of feces, unspecified	Symptom that may prompt evaluation and repair when associated with rectocele and perineal body weakness.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57425`	Colpocleisis, partial or total	Alternative surgical option for pelvic organ prolapse in non-sexually active patients; may be considered instead of reconstructive posterior repair in select patients.
`57240`	Anterior colporrhaphy, repair of cystocele	Often performed concurrently when anterior vaginal wall prolapse coexists with rectocele to restore overall vaginal support.
`57260`	Vaginal vault suspension with graft or mesh	May be performed in conjunction when apical support is deficient and combined pelvic reconstructive approach is required.
`51990`	Repair of enterocele (if performed via vaginal approach)	Related posterior compartment repair when small-bowel herniation into the vaginal canal (enterocele) is present and addressed during the same surgery.
`51782`	Urodynamics (complex)	May be performed preoperatively to evaluate concurrent urinary dysfunction that influences surgical planning.

OpenPayer