CPT 57320 Vaginal Fistula Repair Reimbursement | OpenPayer

Summary & Overview

CPT 57320: Vaginal Repair of Vesicovaginal Fistula

CPT code 57320 represents the surgical repair of a vesicovaginal fistula via a vaginal approach, a procedure that restores separation between the bladder and vagina to stop abnormal urinary flow. Nationally, this code is important for capturing complex pelvic reconstructive procedures performed by gynecology and urology specialists and for payment and quality measurement related to fistula repair. Key payers analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical context of the procedure, typical sites of service, and which major public and private payers commonly cover this intervention. The publication provides benchmarks and policy-relevant details about coding and billing for vaginal vesicovaginal fistula repair, summarizes payer coverage patterns where available, and highlights practical coding considerations that affect reimbursement and claims processing. Data not available in the input are noted where applicable, and clinical context is presented to support coding accuracy and administrative clarity across national payer programs.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare57320CPTvesicovaginal fistulavaginal repairpelvic surgerygynecologyurologysurgical procedureambulatory surgery

Billing Code Overview

CPT code 57320 describes a surgical repair of a vesicovaginal fistula using a vaginal approach. The procedure addresses an abnormal connection between the bladder and the vagina that allows urinary flow into the vaginal canal.

Service type: Surgical repair of a pelvic fistula via vaginal approach
Typical site of service: Hospital inpatient or outpatient surgical setting, ambulatory surgery center, or specialized gynecologic/urologic operating suite

Clinical & Coding Specifications

Clinical Context

A typical patient is a woman presenting with urinary leakage, recurrent urinary tract infections, or continuous drainage following pelvic surgery, obstetric injury, radiation, or pelvic malignancy. Evaluation includes history, pelvic exam with speculum and dye test (eg, methylene blue), cystoscopy to localize the fistula, and imaging as needed. Conservative measures (catheter drainage) may be attempted for small, recent fistulae; persistent or symptomatic vesicovaginal fistula requiring definitive repair is scheduled for surgery. The operative workflow for a vaginal approach (57320) includes preoperative counseling, anesthesia (general, regional, or sedation), bladder catheterization, mobilization of the fistula tract via a transvaginal incision, layered closure of the bladder and vaginal mucosa, possible interposition graft (eg, Martius flap), and placement of prolonged bladder drainage postoperatively. Typical postoperative care involves inpatient or outpatient observation depending on complexity, catheter management for 10–14 days or longer, wound care, and follow-up cystography prior to catheter removal when indicated. Typical sites of service are the hospital operating room or ambulatory surgery center. Typical service type is a surgical procedure (vaginal surgical repair).

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical (eg, extensive reoperation, significant scarring).

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

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

CPT 57285: Paravaginal Defect Repair, Vaginal Approach

CPT-57270-ABDOMINAL-ENTEROCELE-VAGINAL-WALL-REPAIR-HALBAN-MOSCHOWITZ

CPT 57270: Abdominal Repair of Vaginal Wall for Small Bowel Prolapse

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

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

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

CPT 57283: Vaginal Vault Suspension via Vaginal Approach

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

CPT 57260: Vaginal Repair of Bladder and Rectum Prolapse

CPT-57280-ABDOMINAL-VAGINAL-VAULT-SUSPENSION

CPT 57280: Abdominal Vaginal Vault Suspension, Pelvic Reconstructive Surgery

CPT-57250-RECTOCELE-REPAIR-POSTERIOR-VAGINAL-WALL-REPAIR

CPT 57250: Posterior Vaginal Wall Repair (Rectocele) with Perineal Repair

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

CPT 57282: Vaginal Colpopexy (Extraperitoneal) for Apical Suspension

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

CPT 57307: Excision of Rectovaginal Fistula with Colostomy Creation

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Taxonomy Code	Specialty	Notes
`163W00000X`	Female Pelvic Medicine & Reconstructive Surgery	Most common specialty performing complex vaginal fistula repairs.
`207V00000X`	Obstetrics & Gynecology	Frequently performs transvaginal fistula repairs following obstetric injury or gynecologic surgery.
`207L00000X`	Urology	Performs fistula repairs, especially when bladder or ureteral involvement requires urologic expertise.
`207K00000X`	Gynecologic Oncology	Involved when fistula is related to pelvic malignancy or radiation injury.
`310400000X`	General Surgery	May be involved in complex pelvic reconstruction or multi-disciplinary cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N82.1`	Vesicovaginal fistula	Direct diagnosis indicating abnormal communication between bladder and vagina; primary indication for `57320`.
`N36.4`	Urethrovaginal fistula	Fistula involving urethra and vagina; may require similar transvaginal repair techniques.
`N99.89`	Other postoperative genitourinary complications	Captures postoperative complications that can include fistula formation after pelvic surgery.
`C79.11`	Secondary malignant neoplasm of bladder	Malignancy-related fistula may necessitate repair or palliative procedures.
`O70.2`	Third-degree perineal laceration during delivery	Obstetric injury that can predispose to vesicovaginal fistula formation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52000`	Cystourethroscopy, diagnostic; with or without collection of specimen(s) by brushing or washing	Diagnostic cystoscopy performed preoperatively to localize the fistula and assess bladder mucosa.
`57260`	Sling operation for stress urinary incontinence (eg, fascia or synthetic)	Performed concurrently if clinically indicated to address concurrent stress urinary incontinence.
`57240`	Colporrhaphy, repair of cystocele	May be performed concomitantly to repair associated anterior vaginal wall prolapse.
`57290`	Revision of vaginal repair of fistula; vesicovaginal fistula	Used for revision procedures if prior transvaginal repair fails and requires repeat surgery.
`55866`	Transvaginal or perineal repair of fistula (other than vesicovaginal)	Related pelvic fistula repairs when other sites are involved or for combined procedures.

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