CPT Code 57250 Repair Procedures on the Vagina

Accurate CPT coding is critical for OBGYN / urogynecology practices to ensure compliance with CMS and payer rules, avoid claim denials, and obtain proper reimbursement. CPT 57250 is used to report a posterior colporrhaphy (repair of rectocele, with or without perineorrhaphy). Because pelvic floor repairs are a common practice in urogynecology, clear documentation and accurate coding are essential.

This guide (reflecting 2025 AAPC / CMS updates) covers the definition, clinical indications, modifiers, bundling rules, documentation tips, reimbursement, and examples for CPT 57250.

CPT Code 57250 – Description

“Posterior colporrhaphy, repair of rectocele, with or without perineorrhaphy.”

In simpler terms, this procedure entails surgical repair of a posterior vaginal wall defect (rectocele), usually by strengthening and repositioning the rectovaginal septum, and may include repair of the perineal body (perineorrhaphy) if necessary.

• It is not simply excision of tissue or removal of prolapsed organ; it's reconstructive/repair in nature.
• It is not a mesh augmentation code (unless separate mesh/implant codes are used).
• It can be done in conjunction with other vaginal repairs, but bundling and modifier rules must be considered.

When to Use CPT 57250

Appropriate Indications

Use 57250 when a posterior colporrhaphy is performed for:

• A symptomatic rectocele (vaginal wall bulge that involves the rectum pressing into the posterior vaginal wall) causes discomfort, splinting, defecatory dysfunction, pressure sensation, or prolapse symptoms.
• Recurrent rectocele after prior repair, requiring reoperation.
• Rectocele repair is performed along with perineorrhaphy (repair of pthe erineal body) in the same operative session.

When Not to Use 57250

Do not report 57250 when:

• The procedure is simply the excision of an isolated lesion in the posterior vaginal wall - use lesion excision codes.
• The repair is via a transanal or colorectal approach (non–vaginal approach) - those may fall under codes such as 45560. Indeed, when a surgeon describes a perirectal approach or non-colporrhaphy rectocele repair, 45560 might be more appropriate.
• The repair is purely mesh placement (unless the mesh insertion is separately reportable).
• The procedure is incidental to another major surgery and considered included by the surgical package (check bundling rules).
• The defect is purely an enterocele (vaginal vault prolapse) without rectocele – you’d use codes like 57268 or others in that scenario.

Coding Guidelines For CPT Code 57250 & Bundling Rules

• Single procedure reporting: Report 57250 once per surgical session for the posterior colporrhaphy repair (with or without perineorrhaphy).
• Bundle with anterior repairs: If both anterior and posterior repairs are performed, use 57260 (combined anteroposterior colporrhaphy) instead of separate codes 57240 and 57250, unless the payer allows separate billing.
• Vaginal hysterectomy combined repairs: If a vaginal hysterectomy is performed and the surgeon also does a posterior repair (rectocele) with perineorrhaphy, 57250 may be reported together with the vaginal hysterectomy CPT, but only with a PTP (Procedure-to-Procedure) associated modifier, per NCCI rules.
• Multiple procedure reduction: If multiple major procedures are performed in the same session, apply the standard multiple procedure fee reductions as per payer/CMS policy.
• Distinct procedural service (modifier 59 / XS / XE / XP / XU): Use only if another unrelated procedure is done that is not normally bundled, and is truly distinct (different operative field, separate incision). Be cautious - many payers scrutinize modifier 59 in pelvic floor surgery.
• Modifiers 54/55: These may be used if splitting surgical from postoperative management (if payer allows).
• Modifiers LT / RT: Laterality modifiers are not commonly used for vaginal repairs because the concept of “left vs right” is less applicable to midline pelvic floor repairs. Most payers will not accept LT/RT on 57250.
• Modifier 51: Rarely needed if multiple different procedures (but check payer policy).

Documentation Requirements (Checklist for Compliance)

To support medical necessity and avoid denials, thorough operative and clinical documentation is mandatory. Include:

• Preoperative clinical indication: symptoms (bulge, defecatory dysfunction, splinting, obstructed defecation), physical exam findings (site, size of bulge, severity).
• Anatomic description: location and extent of rectocele, involvement of vaginal wall, descent/defect measurements if possible.
• Details of repair: surgical technique (plication, imbrication, muscle/fascial repair, flap advancement), suture types, layers, and how the rectovaginal septum was reinforced.
• Perineorrhaphy details: if performed, document what perineal tissues were repaired, how, and the extent of reconstruction.
• Intraoperative findings: any concurrent defects, adhesions, any coexisting pathology, and surgical challenges.
• Associated procedures: clearly mark what other repairs or interventions were done (e.g., anterior colporrhaphy, hysterectomy, sling procedure) and whether they were contiguous or separate.
• Postoperative plan: follow-up, restrictions, anticipated recovery, and prevention of complications.
• Pathology report: if any tissue was submitted, note submission and result.
• Operative time and laterality (if applicable), anesthesia type, and patient consent.
• Justification of medical necessity: relate symptoms and findings to the need for repair, not merely cosmetic.

This level of documentation helps support the claim and guard against audits or denials.

Reimbursement & Payer Considerations For CPT Code 57250 

• Medicare/ASC/Hospital outpatient payments: According to a pelvic health coding & payment guide, 57250 falls under APC/Grouper 5415, with a status indicator of J1, and Medicare outpatient allowed amounts are similar to those for 57240 and 57260.
• Multiple procedure reduction: As with most major procedures, combining them with other surgeries in the same session may be eligible for reductions.
• Global period: Check payer policy; often pelvic floor repairs are under a 90-day global surgical package (preoperative, intraoperative, and postoperative included). Confirm with each payer.
• Prior authorization: Some commercial payers or Medicare Advantage plans may require preauthorization for pelvic floor reconstructive surgery; verify the policy before scheduling.
• Commercial payer variation: Reimbursement rates vary widely by region, contract, facility vs ambulatory surgery center vs hospital outpatient department. Always check your contract and payer fee schedule.
• Bundling edits: Be aware that NCCI edits might require the use of modifiers (PTP modifiers) when 57250 is paired with hysterectomy or other pelvic surgery.
• Claim coding review: Some payers may lump simple repairs into “vaginal reconstruction” or “pelvic floor repair” categories, so make sure documentation justifies the individual code 57250 rather than a catch-all.

Example Scenarios

Scenario 1 – Isolated Rectocele Repair

A patient presents with a symptomatic rectocele confirmed on exam (posterior vaginal bulge, splinting). The surgeon performs posterior colporrhaphy with plication of the rectovaginal septum. No anterior repair, no hysterectomy.

•  Bill 57250 (posterior colporrhaphy, with or without perineorrhaphy).

Scenario 2 – Rectocele + Perineal Repair

A patient has rectocele plus a lax perineal body. Surgeon repairs the rectocele and performs perineorrhaphy in the same session.

• Bill 57250, as the code includes “with or without perineorrhaphy.”

Scenario 3 – Combined Anterior and Posterior Repairs

A patient has both a cystocele (anterior defect) and a rectocele. The surgeon repairs both in one session.

• Bill 57260 (combined anteroposterior colporrhaphy) rather than separate 57240 + 57250 (unless payer policy allows separate).

Scenario 4 – Hysterectomy + Rectocele Repair

During a vaginal hysterectomy, the surgeon detects a rectocele and performs posterior repair with perineorrhaphy.

• Bill the vaginal hysterectomy CPT plus 57250 with a PTP modifier (per NCCI rules) to indicate that the colporrhaphy is an additional distinct repair.

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