CPT 57268 Vaginal Repair — Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 57268: Vaginal Repair for Small Bowel Prolapse

CPT code 57268 denotes a vaginal surgical repair addressing small bowel prolapse into the vaginal canal. This gynecologic procedure restores pelvic support and closes the defect in the vaginal wall through a vaginal approach. The code is clinically important because it reflects care for advanced pelvic organ prolapse with bowel involvement, a condition that can cause pain, bowel dysfunction, and risk of incarceration. Use of this code affects hospital and ambulatory surgical reporting, clinical quality tracking, and payer coverage determinations nationwide.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service where it is performed, and a summary of payer coverage themes. The publication also provides benchmarking context where available, notes on coding specificity for vaginal approach repairs, and highlights areas where policy and billing practices commonly vary across payers. Data not available in the input is noted where applicable. This content is intended to inform coding professionals, billing managers, and clinical leaders about the role of CPT code 57268 in surgical gynecologic care and reimbursement workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare57268CPTvaginal repairpelvic organ prolapsesurgical gynecologyambulatory surgeryhospital inpatientoperating room

Billing Code Overview

CPT code 57268 describes a surgical repair of the vaginal wall to correct a small bowel prolapse into the vaginal canal performed via a vaginal approach. This procedure involves repairing the defect in the vaginal wall where bowel is protruding to restore normal anatomy and prevent further herniation.

Service type: Surgical repair of vaginal wall for small bowel prolapse (vaginal approach)
Typical site of service: Hospital inpatient or outpatient surgical suite; commonly performed in a hospital operating room or ambulatory surgery center depending on clinical factors and payer policies.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a postmenopausal woman presenting with pelvic pressure, a visible or palpable bulge at the vaginal introitus, and intermittent pelvic or lower abdominal discomfort. Examination reveals an enterocele — herniation of small bowel into the upper vagina — confirmed by pelvic exam and imaging (ultrasound or MRI) as needed. The clinical workflow includes preoperative evaluation (history, pelvic exam, optimization of comorbidities), informed consent discussing vaginal repair, perioperative antibiotics as indicated, anesthesia (general, regional, or monitored anesthesia care), and a vaginal repair of enterocele using 57268 (vaginal approach). Postoperative management includes pain control, activity restrictions, wound and vaginal cuff care, follow-up pelvic exam to assess repair integrity, and instructions for avoiding heavy lifting and constipation. Typical hospitalization is outpatient or short observation depending on comorbidities and intraoperative findings.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier / standard reporting	Use when no specific modifier applies and standard reporting is required.
`22`

CPT 57295: Revision or Removal of Prosthetic Vaginal Graft

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

CPT 57311: Urethrovaginal Fistula Repair with Bulbocavernosus Muscle Flap

CPT-57285-PARAVAGINAL-DEFECT-REPAIR-VAGINAL-APPROACH

CPT 57285: Paravaginal Defect Repair, Vaginal Approach

CPT-57300-RECTOVAGINAL-FISTULA-CLOSURE-VAGINAL-OR-TRANSANAL-APPROACH

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

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

CPT 57292: Vaginoplasty with Graft, Construction of Artificial Vagina

CPT-57287-SLING-REMOVAL-UNDER-URETHRA

CPT 57287: Removal of Urethral Sling for Stress Urinary Incontinence

CPT-57288-URETHRAL-SLING-FOR-STRESS-URINARY-INCONTINENCE

CPT 57288: Urethral Sling for Stress Urinary Incontinence

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

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

CPT-57283-VAGINAL-VAULT-SUSPENSION-VAGINAL-APPROACH

CPT 57283: Vaginal Vault Suspension via Vaginal Approach

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

CPT 57282: Vaginal Colpopexy (Extraperitoneal) for Apical Suspension

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Taxonomy Code	Specialty	Notes
`207V00000X`	Obstetrics & Gynecology	General gynecologic surgeons commonly perform vaginal enterocele repairs.
`207VP0800X`	Female Pelvic Medicine & Reconstructive Surgery (FPMRS)	Specialists in pelvic floor reconstruction frequently perform and manage complex vaginal prolapse repairs.
`2080P0005X`	General Surgery	General surgeons with pelvic surgery experience may be involved in complex or combined abdominal/pelvic procedures.
`207L00000X`	Gynecologic Oncology	Gynecologic oncologists may perform vaginal repairs when malignancy or prior oncologic surgery complicates anatomy.
`367A00000X`	Urogynecology (if different taxonomy used)	Clinicians focused on pelvic floor disorders who perform reconstructive vaginal procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.8`	Other specified diseases of anus and rectum	Occasionally used when rectal support defects coexist; include only if documented.
`N81.49`	Other female genital prolapse, unspecified	Used for prolapse diagnoses that include enterocele when a more specific code is not selected.
`N81.3`	Rectocele	Relevant when posterior vaginal wall defect coexists with enterocele and combined repair is performed.
`N81.2`	Cystocele	Relevant when anterior vaginal wall defect coexists and may be repaired concurrently.
`N81.6`	Enterocele	Directly describes small bowel herniation into the vaginal canal and is the primary diagnosis for `57268`.
`K59.0`	Constipation	Clinically relevant as chronic constipation can contribute to pelvic organ prolapse and is commonly addressed in management.
`N39.3`	Stress urinary incontinence (SUI)	Frequently coexists with pelvic organ prolapse; may prompt combined procedures during the same operative session.
`Z48.02`	Encounter for removal of sutures	May be used postoperatively when suture or vaginal pack removal is performed.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57240`	Repair, enterocele (vaginal approach) — alternative coding historically used for some vaginal enterocele repairs	Sometimes used for isolated enterocele repair; verify payer preference and code definitions relative to `57268`.
`57260`	Combined anterior and posterior repair (colporrhaphy, repair of cystocele and rectocele)	Performed when concurrent anterior or posterior vaginal wall defects are present with enterocele; may be reported with `57268` when separate anatomic repairs are done.
`57426`	Colposcopy with biopsy, loop electrode excision — sample gynecologic procedures that may be performed concurrently	May be performed in the same operative session if mucosal lesions are identified and require sampling.
`51990`	Repair of vaginal cuff or enterocele via laparoscopic approach (example of an abdominal/laparoscopic alternative)	Represents an abdominal/laparoscopic approach; relevant when intraoperative conversion or combined approaches occur.
`57267`	Colpopexy, vaginal, with sacrospinous fixation or other fixation — pelvic support procedures	May be performed adjunctively to restore apical support when treating enterocele; often reported in the same operative episode.

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