CPT 57310 Urethrovaginal Fistula Repair Reimbursement | OpenPayer

Summary & Overview

CPT 57310: Urethrovaginal Fistula Repair, Vaginal Approach

CPT code 57310 denotes surgical repair of a urethrovaginal fistula performed via a vaginal approach. This procedure is clinically significant because urethrovaginal fistulae can cause urinary incontinence, recurrent infections, and substantial quality-of-life impacts; timely and effective surgical repair is central to restoring function. Nationally, billing for this procedure spans commercial insurers and public payers given its surgical nature and typical setting in an ambulatory surgical center or hospital operating room.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise breakdown of clinical context, typical sites of service, common billing modifiers and documentation considerations (where available), and related coding references. The publication summarizes benchmarks and payer coverage patterns, outlines coding nuances for surgical fistula repair via vaginal approach, and highlights areas where coding accuracy affects claims processing and reimbursement.

This overview is intended for clinicians, coding professionals, and policy analysts seeking a clear, national-level summary of CPT code 57310, its clinical role, and the billing context that affects claims and payment for urethrovaginal fistula repair.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare57310CPTurogynecologyfistula repairsurgical procedurevaginal approachambulatory surgeryoperative coding

Billing Code Overview

CPT code 57310 describes the surgical repair of a urethrovaginal fistula using a vaginal approach. This procedure addresses an abnormal connection between the urethra and the vagina to restore normal anatomy and function.

Service type: Surgical repair, gynecologic/urologic reconstructive procedure
Typical site of service: Ambulatory surgical center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A 36-year-old woman presents with continuous urinary leakage through the vagina several months after a complicated vaginal delivery that required instrumental assistance. She reports urinary incontinence unresponsive to conservative measures and recurrent urinary tract irritation. Physical exam and dye testing confirm a urethrovaginal fistula. The clinical workflow includes preoperative evaluation (history, pelvic exam, urinalysis, urine culture, imaging as needed with cystoscopy), counseling regarding risks and alternatives, optimization of infection or inflammation, scheduling a planned operative repair via a vaginal approach, perioperative prophylactic antibiotics, regional or general anesthesia, transvaginal exposure and multilayer closure of the fistulous tract with tissue interposition as indicated, postoperative catheter drainage typically for 7–14 days, voiding trial, and follow-up to assess healing and continence. Typical site of service is an ambulatory surgery center or hospital operating room. Service type is surgical repair — transvaginal urethrovaginal fistula repair (57310).

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier; default submission	Use when no special circumstances or modifiers apply

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

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

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

CPT-57307-ABDOMINAL-EXCISION-RECTOVAGINAL-FISTULA-WITH-COLOSTOMY

CPT 57307: Excision of Rectovaginal Fistula with Colostomy Creation

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

CPT 57308: Rectovaginal Fistula Repair via Perineal Approach

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

CPT 57220: Urethral Reduction and Support Surgery

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

CPT 57260: Vaginal Repair of Bladder and Rectum Prolapse

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

CPT 57288: Urethral Sling for Stress Urinary Incontinence

CPT-57291-VAGINOPLASTY-WITHOUT-GRAFT-VAGINAL-AGENESIS

CPT 57291: Construction of Artificial Vagina without Graft

CPT-57320-VAGINAL-REPAIR-VESICOVAGINAL-FISTULA

CPT 57320: Vaginal Repair of Vesicovaginal Fistula

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

CPT 57265: Vaginal Repair of Pelvic Organ Prolapse with Enterocele

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Taxonomy Code	Specialty	Notes
208W00000X	Female Pelvic Medicine & Reconstructive Surgery	Specialists in pelvic floor and urethral fistula repairs
208000000X	Obstetrics & Gynecology	Gynecologic surgeons commonly perform transvaginal fistula repairs
207RH0000X	Urology	Urologists manage urethral fistula diagnosis and repair techniques
2084P0800X	Reconstructive Plastic Surgery	May be involved for complex tissue interposition or flap reconstruction
208D00000X	General Surgery	Occasionally involved for complex pelvic reconstructive cases requiring multidisciplinary care

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N36.1`	Fistula and diverticulum of bladder	May be used when bladder involvement or vesicovaginal component is present alongside urethrovaginal fistula evaluation
`N36.9`	Urinary tract fistula, unspecified	General code for urinary fistula when specific site not otherwise specified; may be used prior to definitive localization
`N39.3`	Stress incontinence (female)	Coexisting urinary incontinence may be present and evaluated during repair planning
`N99.89`	Other postprocedural complications and disorders of genitourinary system, not elsewhere classified	Used for complications leading to fistula formation after prior pelvic surgery or procedures
`O71.3`	Obstetric trauma to urethra and bladder during delivery	Relevant when fistula follows childbirth-related pelvic trauma
`N48.1`	Urethral diverticulum	Urethral pathology that can be associated with fistula formation or may be addressed concurrently
`N76.1`	Subacute and chronic vaginitis	Local infection or inflammation that can complicate healing and may require management before repair

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52000`	Cystourethroscopy, with or without collection of specimen(s) by brushing or washing, with or without catheterization	Diagnostic cystourethroscopy performed preoperatively or intraoperatively to localize fistula and evaluate urethra and bladder
`57240`	Vaginal fistula repair (colovaginal, etc.), not ureterovaginal	Used for other types of vaginal fistula repairs; relevant if surgeon addresses concurrent vaginal fistula types
`57260`	Repair of enterocele, vaginal vault prolapse (colporrhaphy, etc.)	Performed if concomitant pelvic organ prolapse repair is needed during same operative session
`57425`	Colposcopy of the cervix including upper/adjacent vagina; diagnostic, with biopsy(s)	Performed when vaginal lesions need assessment prior to or during repair (diagnostic adjunct)
`52450`	Urethroplasty, repair of urethral stricture, single-stage; including dilation and/or internal urethrotomy when performed	May be performed if concomitant urethral reconstruction is required alongside fistula repair
`51702`	Insertion of temporary indwelling catheter (e.g., Foley)	Often performed postoperatively for bladder drainage and to protect the repair; may be separately reported when billed independently

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