CPT 57260 Vaginal Repair Reimbursement | OpenPayer

Summary & Overview

CPT 57260: Vaginal Repair of Bladder and Rectum Prolapse

CPT code 57260 represents a vaginal approach surgical repair of pelvic organ prolapse in which vaginal tissues are reconstructed to support weakened areas and restore the bladder and rectum to their normal positions. This code is used when a patient presents with both bladder prolapse into the vaginal canal and rectal prolapse into the vaginal canal; cystourethroscopy may be performed but is optional. Nationally, this procedure matters because pelvic organ prolapse is common among women and can require surgical intervention to relieve symptoms and improve quality of life.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is used, the typical sites of service (hospital OR or ambulatory surgical center via vaginal approach), and operational considerations relevant to billing and coding workflows. The publication also provides benchmarks and policy-relevant updates where available, plus practical guidance on documentation elements to support use of CPT code 57260. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 57260pelvic organ prolapsevaginal repairurogynecologysurgical procedureambulatory surgeryhospital outpatientgynecologypelvic floor repair

Billing Code Overview

CPT code 57260 describes a vaginal surgical repair in which the provider repairs vaginal tissues over weakened areas to support the pelvic floor and restore normal positions of the bladder and rectum. The procedure addresses pelvic organ prolapse involving the bladder (cystocele) and rectum (rectocele) and may include cystourethroscopy at the provider's discretion.

Service type: Pelvic organ prolapse repair via vaginal approach
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center, performed through a vaginal approach

Clinical & Coding Specifications

Clinical Context

A 62-year-old parous woman presents with vaginal pressure, urinary incontinence, and difficulty emptying her bladder. Pelvic exam demonstrates anterior and posterior vaginal wall prolapse with descent of the bladder (cystocele) and rectum (rectocele) into the vaginal canal. Conservative measures including pelvic floor physical therapy and pessary use have failed. The planned procedure is a vaginal repair of the vaginal tissues to restore support and reposition the bladder and rectum, performed in an operating room under regional or general anesthesia. Intraoperative cystourethroscopy may be performed to evaluate the urethra and bladder for injury or concomitant pathology. Typical workflow: preoperative evaluation and informed consent, anesthesia induction, vaginal exposure and identification of fascial defects, anterior and/or posterior colporrhaphy with plication of weakened fascia and possible levator repair, intraoperative cystourethroscopy if indicated, hemostasis, vaginal packing as needed, postanesthesia recovery, and postoperative counseling for activity restrictions and pelvic floor rehabilitation.

Coding Specifications

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

CPT 57300: Closure of Small Rectovaginal Fistula, Vaginal or Transanal

CPT-57287-SLING-REMOVAL-UNDER-URETHRA

CPT 57287: Removal of Urethral Sling for Stress Urinary Incontinence

CPT-57335-VAGINOPLASTY-USING-EXISTING-TISSUE

CPT 57335: Vaginoplasty Using Existing Tissue

CPT-57305-ABDOMINAL-EXCISION-RECTOVAGINAL-FISTULA

CPT 57305: Abdominal Excision of Rectovaginal Fistula

CPT-57284-PARAVAGINAL-DEFECT-REPAIR-ABDOMINAL-APPROACH

CPT 57284: Paravaginal Defect Repair, Abdominal Approach

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

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

CPT-57230-URETHROCELE-REPAIR-URETHRAL-PROLAPSE-REPAIR

CPT 57230: Repair of Urethrocele (Urethral Prolapse into Vagina)

CPT-57295-VAGINAL-GRAFT-REVISION-REMOVAL

CPT 57295: Revision or Removal of Prosthetic Vaginal Graft

CPT-57268-VAGINAL-REPAIR-SMALL-BOWEL-PROLAPSE

CPT 57268: Vaginal Repair for Small Bowel Prolapse

CPT-57282-VAGINAL-COLPOPEXY-EXTRAPERITONEAL-VAULT-REPAIR

CPT 57282: Vaginal Colpopexy (Extraperitoneal) for Apical Suspension

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Taxonomy Code	Specialty	Notes
208100000X	Obstetrics & Gynecology	Primary specialty that performs vaginal pelvic reconstructive surgery.
2080P0901X	Female Pelvic Medicine & Reconstructive Surgery (FPMRS)	Subspecialists who frequently perform complex prolapse repairs.
2086S0122X	Urogynecology	Focused practice for pelvic floor disorders; often manages multi-compartment prolapse.
207RH0000X	Reproductive Endocrinology/Infertility	Occasionally involved for complex pelvic surgery planning (less common).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N81.10`	Uterovaginal prolapse, unspecified	General code for pelvic organ prolapse that may accompany cystocele/rectocele addressed by this repair.
`N81.2`	Cystocele	Direct indication for vaginal anterior repair to support the bladder.
`N81.3`	Rectocele	Direct indication for posterior vaginal repair to support the rectum.
`N81.4`	Enterocele	May be present with posterior vaginal wall defects and repaired during the same operation.
`N39.3`	Stress incontinence (female)	Often coexists with prolapse; may prompt concurrent or staged continence procedures.
`R32`	Unspecified urinary incontinence	Symptom commonly evaluated and may be related to pelvic organ prolapse.
`O34.8XX0`*	Other specified maternal care (placeholder)	Data not applicable; only include clinically standard codes above.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57260`	Repair of enterocele, cystocele and/or rectocele; via vaginal approach (anterior and/or posterior colporrhaphy)	Primary procedure to correct bladder and rectal prolapse into the vaginal canal.
`57425`	Colposcopy of the cervix, with biopsy(s) of the cervix, with endocervical curettage	May be performed preoperatively or intraoperatively if abnormal cervical findings require evaluation.
`52287`	Cystourethroscopy, with ureteroscopy, with removal of calculus or foreign body; without dilation	`57260` may be accompanied by diagnostic cystourethroscopy; report the appropriate cystoscopy code when performed.
`57106`	Revision (including tightening) of a sling for stress incontinence	May be performed concurrently or staged if stress urinary incontinence is present with prolapse.
`57240`	Colpopexy, abdominal approach, with or without mesh	Alternative or additional procedure when an abdominal or laparoscopic approach is chosen for apical support rather than a vaginal-only repair.

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