CPT 57284 Paravaginal Repair Reimbursement | OpenPayer

Summary & Overview

CPT 57284: Paravaginal Defect Repair, Abdominal Approach

CPT code 57284 denotes an abdominal approach to repair a paravaginal defect, with cystocele repair included when performed. This pelvic reconstructive surgery is clinically important for restoring pelvic support and addressing symptomatic anterior vaginal wall prolapse that compromises quality of life. Nationally, the code is used across hospital and ambulatory surgery settings for procedures performed by urogynecology, gynecology, and pelvic reconstructive specialists.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical context, typical sites of service, and common billing practices tied to the code. Readers will find benchmarks for utilization and payment where available, summaries of relevant policy considerations affecting coverage and coding, and guidance on documentation elements that support medical necessity. Where payer-specific terms or data are not provided in the input, the report notes that the information is not available.

This summary is intended for health plan analysts, billing professionals, and clinical leaders seeking a clear, national-level reference for CPT code 57284, its clinical meaning, and the practical billing context in which the procedure is performed.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare57284CPTpelvic-reconstructive-surgeryparavaginal-repaircystocele-repairabdominal-approachurogynecology

Billing Code Overview

CPT code 57284 describes a surgical repair of a paravaginal defect using an abdominal approach. The procedure includes repair of a cystocele when performed as part of the same operation.

Service type: Surgical repair (pelvic reconstructive surgery)

Typical site of service: Hospital operating room or ambulatory surgery center, using an abdominal (open or minimally invasive) approach for pelvic floor reconstruction.

Clinical & Coding Specifications

Clinical Context

A 56-year-old woman with symptomatic anterior vaginal wall prolapse (paravaginal defect) presents with urinary frequency, pelvic pressure, and a visible bulge that worsens with Valsalva. She has failed conservative therapy including pelvic floor physical therapy and pessary use. Preoperative evaluation includes history and physical, pelvic exam quantifying prolapse (POP-Q), urinalysis, and appropriate medical clearance. The patient is scheduled for an abdominal paravaginal repair (57284) under general anesthesia. Intraoperative workflow commonly includes cystoscopy to evaluate for bladder injury, ureteral patency assessment if indicated, and concurrent cystocele repair when present. Postoperative care includes monitoring for urinary retention, pain control, prophylactic antibiotics as indicated, and follow-up visits to assess wound healing and prolapse correction. Hospital or ambulatory surgical center staff coordinate perioperative orders, documentation of the operative note specifying the abdominal approach and repair details, and coding/billing using 57284 with appropriate modifiers for circumstances such as bilateral procedures, additional operative complexity, or professional vs technical components.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

CPT 57292: Vaginoplasty with Graft, Construction of Artificial Vagina

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

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

CPT-57289-CYSTOCELE-AND-STRESS-URINARY-INCONTINENCE-VAGINAL-REPAIR

CPT 57289: Repair of Cystocele and Stress Urinary Incontinence, Vaginal Approach

CPT-57305-ABDOMINAL-EXCISION-RECTOVAGINAL-FISTULA

CPT 57305: Abdominal Excision of Rectovaginal Fistula

CPT-57310-URETHROVAGINAL-FISTULA-REPAIR-VAGINAL-APPROACH

CPT 57310: Urethrovaginal Fistula Repair, Vaginal Approach

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

CPT 57288: Urethral Sling for Stress Urinary Incontinence

CPT-57280-ABDOMINAL-VAGINAL-VAULT-SUSPENSION

CPT 57280: Abdominal Vaginal Vault Suspension, Pelvic Reconstructive Surgery

CPT-57335-VAGINOPLASTY-USING-EXISTING-TISSUE

CPT 57335: Vaginoplasty Using Existing Tissue

CPT-57240-ANTERIOR-VAGINAL-WALL-REPAIR-CYSTOCELE

CPT 57240: Anterior Vaginal Wall Repair (Cystocele)

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

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

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Taxonomy Code	Specialty	Notes
206E00000X	Obstetrics & Gynecology	Most common specialty performing abdominal paravaginal repair.
207V00000X	Female Pelvic Medicine & Reconstructive Surgery	Subspecialists who manage complex pelvic organ prolapse and paravaginal repairs.
2080P0208X	Urogynecology	Clinicians focused on pelvic floor disorders; often perform `57284`.
363L00000X	General Surgery	May perform abdominal pelvic floor repairs in some settings.
2080S0121X	Gynecologic Oncology	Performs abdominal pelvic procedures when concurrent pathology requires gynecologic oncology involvement.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N81.0`	Urethrocele	Anterior compartment prolapse often associated with paravaginal defects; may be corrected during paravaginal repair.
`N81.1`	Cystocele	Bladder prolapse frequently coexists with paravaginal defects; `57284` includes cystocele repair when performed via an abdominal approach.
`N81.3`	Rectocele	Posterior compartment defect that may be repaired in concurrent procedures when multicolumn prolapse is present.
`N81.4`	Uterovaginal prolapse	Apical support defects may be addressed concurrently with paravaginal repair depending on surgical plan.
`N81.2`	Incomplete uterovaginal prolapse	An element of multicomponent prolapse that can influence the need for paravaginal repair.
`N81.6`	Pelvic organ prolapse, unspecified	Used when specific compartment is not specified in documentation but prolapse necessitates surgical repair.
`R32`	Unspecified urinary incontinence	May be present with anterior compartment defects and considered in perioperative assessment.
`Z48.02`	Encounter for removal of sutures	Postoperative care code used in follow-up visits after procedures like `57284`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57240`	Repair of enterocele (vaginal approach)	Alternative or adjunct pelvic support procedure when posterior compartment defects are present; may be performed in the same operative session depending on compartments involved.
`57250`	Colpopexy, abdominal approach including mesh when performed	Often performed concurrently or instead of paravaginal repair for apical prolapse; may be combined when multicomponent prolapse is addressed.
`51715`	Cystourethroscopy, with or without injection	Diagnostic cystoscopy is commonly performed during or after `57284` to evaluate bladder integrity and ureteral efflux.
`57288`	Colporrhaphy, repair of cystocele, vaginal approach; with graft (biologic or synthetic)	Vaginal cystocele repairs may be performed if the approach is transvaginal; `57284` includes cystocele repair when performed via abdominal approach.
`57460`	Colposcopy of lower/upper genital tract	Preoperative assessment of vaginal mucosa and lesions when indicated; not routinely performed for `57284` but may be part of preop workup.
`51840`	Repair of urethral-vaginal fistula	Addressed if intraoperative injury or fistula is present; related to pelvic reconstructive procedures when complications arise.

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