CPT 57295 Vaginal Graft Removal Reimbursement | OpenPayer

Summary & Overview

CPT 57295: Revision or Removal of Prosthetic Vaginal Graft

CPT code 57295 represents the revision or removal of a previously placed prosthetic vaginal graft performed via a vaginal approach. It applies when mesh has eroded into tissue or become exposed due to thinning of overlying tissue, requiring surgical intervention. Nationally, this code is important as concerns about pelvic mesh complications have driven utilization, regulatory scrutiny, and payer coverage reviews.

Key payers commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for mesh removal, typical sites of service (ambulatory surgical centers and hospital operating rooms), and what to expect in billing workflows. The publication also outlines common modifiers and coding nuances, benchmarks where available, and recent policy updates that affect prior authorization and coverage criteria.

This resource is intended for coding professionals, clinicians, and policy analysts who need a concise reference to CPT code 57295, including its clinical indication and administrative considerations. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 57295vaginal meshpelvic reconstructive surgerygraft removalgynecologic surgerysurgical codingambulatory surgerymesh erosion

Billing Code Overview

CPT code 57295 describes the revision or removal of a previously placed prosthetic vaginal graft via a vaginal approach. The procedure is performed when the graft has eroded into surrounding tissue or when thinning of the overlying tissue has exposed the mesh, necessitating partial or complete removal or revision.

Service type: Surgical procedure — revision or removal of prosthetic vaginal graft
Typical site of service: Ambulatory surgical center or hospital-based operating room with a vaginal surgical approach

Clinical & Coding Specifications

Clinical Context

A 58-year-old woman with a history of transvaginal mesh placement for pelvic organ prolapse presents with vaginal pain, recurrent discharge, and visualization of synthetic mesh through the vaginal epithelium. Examination confirms mesh erosion/exposure with localized inflammation but no signs of systemic infection. After counseling, the patient is scheduled for operative revision and removal of the eroded prosthetic vaginal graft via a vaginal approach under regional or general anesthesia. The clinical workflow includes preoperative evaluation (history, pelvic exam, targeted cultures if purulent drainage), informed consent documenting risks of recurrent prolapse and need for possible concurrent prolapse repair, perioperative antibiotics per facility protocol, vaginal approach for dissection and partial or complete graft excision, hemostasis, layered closure of vaginal epithelium, and postoperative follow-up for wound healing and pelvic floor function. Documentation should specify the reason for removal (erosion/exposure), extent removed (partial versus complete), approach as vaginal, anesthesia type, intraoperative findings, and any concurrent procedures performed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, and complexity substantially exceed typical for `57295` and adequately documented.

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

CPT-57280-ABDOMINAL-VAGINAL-VAULT-SUSPENSION

CPT 57280: Abdominal Vaginal Vault Suspension, Pelvic Reconstructive Surgery

CPT-57265-VAGINAL-REPAIR-PELVIC-ORGAN-PROLAPSE-ENTEROCELE

CPT 57265: Vaginal Repair of Pelvic Organ Prolapse with Enterocele

CPT-57260-VAGINAL-REPAIR-BLADDER-RECTUM-PROLAPSE

CPT 57260: Vaginal Repair of Bladder and Rectum Prolapse

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

CPT 57311: Urethrovaginal Fistula Repair with Bulbocavernosus Muscle Flap

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

CPT 57240: Anterior Vaginal Wall Repair (Cystocele)

CPT-57200-VAGINAL-WALL-LACERATION-REPAIR

CPT 57200: Repair of Nonobstetric Vaginal Wall Laceration

CPT-57335-VAGINOPLASTY-USING-EXISTING-TISSUE

CPT 57335: Vaginoplasty Using Existing Tissue

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

CPT 57268: Vaginal Repair for Small Bowel Prolapse

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
`2084P0805X`	Obstetrics & Gynecology	Gynecologic surgeons commonly perform transvaginal graft removals.
`207Z00000X`	Female Pelvic Medicine & Reconstructive Surgery	Specialists in pelvic floor reconstruction manage complex mesh erosions and revisions.
`207L00000X`	Urogynecology	Urogynecologists perform evaluation and surgical management of pelvic organ prolapse and mesh complications.
`208000000X`	General Surgery	General surgeons with pelvic reconstruction experience may be involved in complex cases.
`363L00000X`	Anesthesiology	Anesthesiologists provide regional or general anesthesia for the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N99.89`	Other postprocedural disorders and complications of genitourinary system, not elsewhere classified	Captures complications related to prior pelvic prosthetic grafts such as pain or dysfunction.
`T85.79XA`	Other complication of internal prosthetic device, initial encounter	Used for complications of pelvic mesh including erosion or exposure on initial presentation.
`T85.79XD`	Other complication of internal prosthetic device, subsequent encounter	Used for follow-up encounters related to prosthetic device complications.
`N76.0`	Acute vaginitis	May be present with purulent discharge when mesh erosion causes local infection.
`N91.2`	Amenorrhea, unspecified	Occasionally documented but not specific; include only if clinically relevant (Data not available in the input).
`N94.89`	Other specified conditions associated with female genital organs and menstrual cycle	Used for pain or other genital symptoms related to mesh erosion.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`57240`	Repair of enterocele, vaginal approach	May be performed concurrently if pelvic organ prolapse repair is required after mesh removal.
`57260`	Anterior colporrhaphy, repair of cystocele	Commonly performed before or after mesh excision to restore anterior vaginal wall support.
`57267`	Repair of rectocele, posterior colporrhaphy	Performed when posterior compartment prolapse is present alongside mesh complications.
`57288`	Colpopexy, abdominal or sacral (lap/abdominal)	May be planned if mesh removal results in recurrent apical prolapse requiring abdominal or sacral fixation.
`57454`	Colposcopy with biopsy, single or multiple	Performed preoperatively if suspicious vaginal lesions or for tissue diagnosis related to erosion.

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