CPT 57291 Vaginoplasty Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 57291: Construction of Artificial Vagina without Graft

CPT code 57291 represents vaginoplasty creating an artificial vagina without use of a graft to treat congenital absence of a vagina or vaginal agenesis. The code describes a reconstructive gynecologic procedure performed when native vaginal tissue is absent. Nationally, the code is relevant to specialty surgical practices, hospital surgical departments, and ambulatory surgical centers that provide gender-affirming or congenital anomaly reconstructive services.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the payer mix noted above. The publication provides billing benchmarks, common modifier usage, and coding relationships relevant to surgical and facility billing workflows. It also outlines policy and coverage considerations that influence authorization and reimbursement practices across major national payers.

This summary is intended to orient clinicians, coding professionals, and policy analysts to the clinical purpose of CPT code 57291, the typical care settings, and the areas of payer policy and billing practice that most commonly affect its use.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 57291vaginoplastyreconstructive gynecologyvaginal agenesissurgical procedureambulatory surgeryhospital surgerybilling code

Billing Code Overview

CPT code 57291 describes a surgical procedure to construct an artificial vagina without use of a graft for patients with congenital absence of a vagina or vaginal agenesis. The procedure is a form of vaginoplasty performed to create a functional vaginal canal when the native anatomy is absent.

Service type: Reconstructive gynecologic surgery
Typical site of service: Hospital operating room or ambulatory surgical center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adolescent or young adult assigned female at birth presenting with primary amenorrhea, cyclic pelvic pain, or difficulty with intercourse, and is diagnosed with vaginal agenesis or Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. After multidisciplinary evaluation including gynecology, reproductive endocrinology, and counseling, the patient elects surgical creation of a neovagina when non-surgical dilation has failed or is not feasible. Preoperative workup includes pelvic imaging (MRI or ultrasound) to define anatomy, assessment for renal or skeletal anomalies, laboratory studies, and informed consent addressing fertility and sexual function.

The procedure 57291 is performed in an operating room under general anesthesia by a gynecologic surgeon or pediatric/adolescent gynecologic specialist. Intraoperative steps typically include dissection to create a vaginal canal between the rectum and bladder, creation of a mucosal-lined neovaginal cavity without use of grafts, hemostasis, and placement of stent or dilator. Postoperative care involves inpatient or ambulatory recovery, pain control, prophylactic antibiotics if indicated, instructions for dilation schedule, wound and stent care, and outpatient follow-up with the surgical team and pelvic rehabilitation as needed.

Common clinical documentation elements include indications (congenital absence of vagina), preoperative imaging and exam findings, informed consent, operative report describing technique and absence of graft use, estimated blood loss, any intraoperative complications, and postoperative dilation plan.

Coding Specifications

Modifier	Description	When to Use

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-57220-URETHRAL-REDUCTION-AND-SUPPORT-SURGERY

CPT 57220: Urethral Reduction and Support Surgery

CPT-57335-VAGINOPLASTY-USING-EXISTING-TISSUE

CPT 57335: Vaginoplasty Using Existing Tissue

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

CPT 57284: Paravaginal Defect Repair, Abdominal Approach

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

CPT 57292: Vaginoplasty with Graft, Construction of Artificial Vagina

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

CPT 57308: Rectovaginal Fistula Repair via Perineal Approach

CPT-57296-ABDOMINAL-REMOVAL-REVISION-PROSTHETIC-VAGINAL-GRAFT

CPT 57296: Abdominal Removal/Revision of Prosthetic Vaginal Graft

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`00`	No modifier provided (default)	Use when no specific modifier applies; many payers expect no modifier code entry rather than `00` but it is listed among available modifiers.
`11`	Primary procedure	Use when `57291` is the primary reason for the encounter and the principal procedure performed.
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for `57291`, documented in the operative report.
`52`	Reduced services	Use when the procedure was partially performed or curtailed, with clear documentation of reduced service.
`53`	Discontinued procedure	Use when the procedure was started but stopped due to extenuating circumstances and documented justification.
`62`	Two surgeons	Use when two surgeons with distinct skills performed portions of `57291` and documentation supports concurrent participation.
`63`	Procedure performed on infants less than 4 kg	Use only when patient meets weight criteria and procedure performed on qualifying infant.
`66`	Surgical team approach	Use when a surgical team approach is reported and supported by documentation, commonly in complex reconstructive cases.
`78`	Unplanned return to OR for related procedure following initial surgery	Use when patient returns to the operating room related to the original `57291` within the payer-defined global period.
`79`	(Not in provided modifier list)	Data not available in the input.
`AS`	Ambulatory surgery center facility service	Use to denote the service was provided in an ambulatory surgery center when billing facility charges are reported.
`TC`	Technical component	Use when billing only the technical component of a service (rare for procedural CPTs like `57291` but applicable to associated imaging or pathology).
`QX`	Modifier for assistant at surgery — assistant’s employer attests to non-employee status	Use when an assistant at surgery is reported and the assistant meets attestation requirements.
`QY`	Clinical lab improvement amendments (CLIA) waived testing by provider	Not typically applicable to `57291`; included only if relevant ancillary CLIA-waived testing is billed.

Taxonomy Code	Specialty	Notes
`207V00000X`	Obstetrics & Gynecology	Gynecologic surgeons commonly perform vaginoplasty for agenesis.
`2080P0207X`	Pediatric Gynecology	Specialists in pediatric/adolescent gynecology manage congenital absence of the vagina in minors.
`201V00000X`	Urology	Urologic surgeons may be involved when genitourinary anomalies coexist or for combined procedures.
`261QM0800X`	Plastic and Reconstructive Surgery	Plastic surgeons participate in complex reconstruction or when grafts/advanced techniques are needed.
`1100`	Nurse Practitioner (Women’s Health)	Advanced practice clinicians involved in pre/postoperative care and dilation training.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q52.3`	Vaginal agenesis (Müllerian agenesis)	Primary indication for neovagina construction when nonoperative management fails.
`Q52.0`	Agenesis and aplasia of cervix	Associated müllerian anomalies often evaluated when planning `57291`.
`Q87.8`	Other specified congenital malformation syndromes affecting multiple systems	May be listed when syndromic anomalies accompany vaginal agenesis and affect surgical planning.
`N97.9`	Female infertility, unspecified	Relevant to counseling and documentation regarding reproductive implications of congenital absence of the vagina.
`R87.619`	Abnormal cytology of cervix, unspecified — Data not available in the input.	Data not available in the input.
`Z30.09`	Encounter for contraception counseling and advice	May appear in the patient history but is not a direct indication for `57291`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57425`	Colposcopy of the cervix including upper/adjacent vagina, with biopsy(s) when performed	May be performed preoperatively for evaluation of vaginal mucosa or concurrent biopsy if abnormal tissue is present.
`57288`	Colposuspension for urinary incontinence (sling procedures are `57288` family)	May be performed in the same surgical setting if concomitant pelvic floor reconstruction is required, though not routine with `57291`.
`57454`	Colposcopy of the cervix including upper/adjacent vagina with loop electrode biopsy(s)	May be used for diagnostic evaluation prior to definitive reconstructive surgery if mucosal abnormalities are suspected.
`57460`	Colposcopy of vulva; simple	Performed for evaluation of vulvar pathology before or after neovaginal construction.
`54050`	Circumcision, surgical; neonatal	Data not available in the input.

Note: If any listed CPT descriptions or relationships are inconsistent with a payer or facility policy, payer-specific billing guidelines should be consulted for bundling rules and global periods.

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