Summary & Overview
CPT 57267: Vaginal Prosthetic Graft for Anterior/Posterior Vaginal Wall
CPT code 57267 denotes the vaginal insertion of a prosthetic graft over the anterior and/or posterior vaginal wall when native tissue lacks reasonable strength. As an add-on procedure, it must be billed alongside a primary pelvic reconstructive surgery code. This code is relevant nationally because it captures use of prosthetic material in pelvic organ prolapse and vaginal wall reinforcement procedures, affecting coding accuracy, surgical reporting, and payment for reconstructive pelvic surgery.
Payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find coverage and billing considerations across major payers, typical sites of service, and the clinical context for reporting an add-on vaginal prosthetic graft procedure. The publication provides benchmarks for utilization and coding practice, summarizes policy and coverage trends relevant to prosthetic grafts in vaginal reconstructive surgery, and outlines the clinical scenarios in which 57267 is reported. Data not available in the input are noted where applicable. The content is intended for coders, billing managers, and policy analysts seeking a concise national perspective on coding, coverage, and clinical context for CPT code 57267.
Billing Code Overview
CPT code 57267 describes the insertion of a prosthetic graft over the anterior and/or posterior vaginal wall due to inadequate native tissue strength. The procedure is performed via a vaginal approach and is an add-on procedure, intended to be reported in conjunction with a primary pelvic reconstructive procedure.
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Service type: Pelvic reconstructive surgical add-on
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Typical site of service: Inpatient or outpatient surgical setting with a vaginal approach
Clinical & Coding Specifications
Clinical Context
A typical patient is a postmenopausal woman presenting with symptomatic anterior and/or posterior vaginal wall prolapse (cystocele and/or rectocele) with poor native tissue strength. She reports vaginal bulge, pelvic pressure, urinary symptoms (urgency or incomplete emptying), or difficulty with defecation. Conservative measures (pelvic floor physical therapy, pessary) were attempted or are contraindicated. Preoperative evaluation includes history and pelvic exam confirming pelvic organ prolapse, urodynamic testing if indicated, and optimization of comorbidities. The surgical plan is a transvaginal repair using a synthetic or biologic prosthetic graft placed over the anterior and/or posterior vaginal wall to reinforce deficient fascial support. The procedure is performed in an operating room or ambulatory surgery center under regional or general anesthesia. Intraoperative steps include exposure of the vaginal wall, dissection to the appropriate plane, placement and fixation of the graft to pelvic supportive structures, hemostasis, and layered vaginal closure. 57267 is an add-on code reported in conjunction with the primary vaginal prolapse repair code (for example an anterior or posterior colporrhaphy) and is documented only when prosthetic graft material is implanted because native tissue is inadequate. Typical postoperative care includes recovery monitoring, pain control, instructions on activity restriction, and follow-up visits to assess wound healing and graft integration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |