CPT Code 57260 Complete Billing & Coding Guide for Repair Procedures on the Vagina

Accurate CPT coding is crucial for OB-GYN and urogynecology providers to maintain compliance, avoid payer denials, and ensure fair reimbursement. CPT 57260 is reported when the surgeon performs a combined anterior and posterior colporrhaphy—that is, repair of both cystocele and rectocele during the same surgical session. Because it addresses multiple pelvic floor defects, this code carries specific documentation and bundling considerations that must align with current CMS and AAPC 2025 guidelines.

This detailed guide outlines the code’s definition, medical indications, coding principles, documentation standards, modifier use, and reimbursement considerations so your practice can confidently and compliantly report this procedure.

CPT 57260 – Description

“Combined anteroposterior colporrhaphy.”

This code describes a reconstructive vaginal surgery in which the physician repairs defects of both the anterior (bladder support) and posterior (rectal support) vaginal walls. The goal is to restore normal pelvic anatomy by tightening and reinforcing the endopelvic fascia. 

If perineorrhaphy is performed as part of the same repair, it is included within this code.

The procedure may involve dissection of the vaginal mucosa, plication of the underlying fascia, and re-approximation of tissues to strengthen pelvic support. It is not used for single-site repairs or for prolapse corrections performed via abdominal or laparoscopic approaches.

When to Use CPT 57260

Report CPT 57260 when both anterior and posterior vaginal wall defects are surgically corrected in the same operative field. Common indications include symptomatic cystocele and rectocele causing vaginal bulge, pelvic pressure, urinary dysfunction, or defecatory issues. It may also be appropriate for recurrent multicompartment prolapse following prior repair.

• Do not report 57260 if only one compartment is repaired; use 57240 for anterior repair or 57250 for posterior repair instead. If a vaginal hysterectomy is performed concurrently, 57260 may be billed separately only when the documentation demonstrates a distinct repair beyond the hysterectomy procedure. Enterocele or vault suspension repairs require their own specific codes.

Coding Guidelines and Bundling Rules

CPT 57260 replaces the separate reporting of anterior and posterior repair codes when both are completed together. The global surgical period is ninety days, and postoperative care is included in the package. Perineorrhaphy is inherently bundled and should not be coded separately.

• If the combined colporrhaphy is performed along with another major gynecologic procedure, such as a hysterectomy or sling placement, follow the National Correct Coding Initiative (NCCI) edits. Add an appropriate modifier (such as 59 or XS) only when the operative note clearly shows that the repair was distinct and medically necessary. Multiple-procedure payment reductions may be applied when other major surgeries are performed during the same session.
• Most payers require prior authorization for pelvic reconstructive surgery, particularly Medicare Advantage and commercial plans. Always verify policy requirements and confirm that operative documentation supports medical necessity.

Reimbursement Information CPT Code 57260

For 2025, Medicare and commercial payer data categorize CPT 57260 as a major pelvic floor reconstructive procedure typically performed in a hospital or ambulatory surgical center. Average national reimbursement values fall in the mid-to-high range compared to single-compartment repairs, reflecting the combined complexity of these procedures. Reimbursement amounts vary by geographic region, site of service, and payer contract.

A ninety-day global period applies, encompassing pre-operative evaluation, surgery, and postoperative management. Providers should confirm payer-specific fee schedules, bundling edits, and authorization policies before scheduling surgery to prevent payment delays or denials.

Applicable Modifiers CPT Code 57260

Appropriate modifier use ensures claim accuracy. Modifier 59 or XS may be appended when the combined repair is distinct from another major operation performed at the same session. Modifier 51 applies when multiple unrelated procedures are reported. Modifiers 54 and 55 allow division of surgical and postoperative care if shared between physicians. Modifier 52 indicates a reduced service when the full extent of the procedure cannot be completed. Laterality modifiers are not used for vaginal surgeries.

Documentation Requirements For CPT Code 57260

Comprehensive and specific documentation supports the code selection and validates medical necessity. Operative notes should describe the patient’s symptoms and findings of both anterior and posterior vaginal wall defects, the degree of prolapse, and the impact on bladder and rectal function.

Include a clear description of the surgical technique for each wall, details of fascial plication or reinforcement, the presence or absence of perineorrhaphy, and any intraoperative findings or challenges. If grafts or mesh are used, specify the material and placement. Postoperative instructions and follow-up plans should also be recorded. Accurate, complete documentation protects against payer audits and ensures compliance with CMS and AAPC standards.

Example Scenarios

Scenario 1: A patient presents with symptomatic cystocele and rectocele. The surgeon performs repairs on both compartments during a single operation. → Report CPT 57260.

Scenario 2: A vaginal hysterectomy is performed, followed by a distinct repair of the anterior and posterior vaginal walls to correct prolapse. → Report the hysterectomy code and 57260 with an appropriate modifier if documentation supports a separate, medically necessary repair.

Scenario 3: A recurrent multicompartment prolapse is repaired through vaginal approach with fascial plication and perineorrhaphy. → Report 57260 only; perineorrhaphy is included.

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With extensive experience in OBGYN and urogynecology billing, BillingFreedom has established a strong reputation for precise coding, regulatory accuracy, and payer-specific expertise. Our certified coding professionals consistently interpret complex surgical documentation and apply the most current AAPC and CMS guidelines to procedures such as colporrhaphy, hysterectomy, and vulvectomy. This evidence-based approach has enabled OBGYN practices nationwide to reduce denials and maintain transparent, compliant revenue cycles.

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