CPT Code 57420 Endoscopy/Laparascopy Procedures on the Vagina

Accurate CPT reporting is essential for OBGYN providers to maintain compliance and secure proper reimbursement. CPT 57420 identifies a laparoscopic colpopexy performed with concurrent enterocele repair, a procedure used to restore vaginal support and correct pelvic organ prolapse associated with herniation of the peritoneal sac.

This 2025 guide provides coding, modifier, documentation, and reimbursement details in accordance with the latest AAPC and CMS guidelines, helping OBGYN practices code confidently and minimize denials.

CPT 57420 – Description

Official Definition: “Laparoscopy, surgical, colpopexy (suspension of vaginal apex), with repair of enterocele.”

The procedure involves laparoscopic restoration of vaginal apex support with simultaneous repair of an enterocele. The surgeon repositions and closes the herniated peritoneal sac and suspends the vaginal cuff or cervix to a stable pelvic structure such as the sacral promontory or uterosacral ligament. Mesh or sutures may be used for reinforcement.

CPT 57420 is specific to the laparoscopic approach and includes both repairs performed during the same operative session.

When to Use CPT 57420

Report CPT 57420 when both a laparoscopic vaginal vault suspension and enterocele repair are performed.

Indications for use include:

• Vaginal vault or uterovaginal prolapse with coexisting enterocele.
• Post-hysterectomy vaginal prolapse associated with peritoneal sac herniation.
• Recurrent prolapse requiring laparoscopic correction.

Do not use 57420 when:

• The repair is open abdominal (use 57285) or vaginal (use 57268).
• Only a laparoscopic colpopexy is performed (use 57415).
• Enterocele repair is incidental and not clearly documented.

Coding and Billing Guidelines

CPT 57420 encompasses both the colpopexy and enterocele repair performed laparoscopically; do not report additional codes for these components.

The procedure carries a 90-day global period per the 2025 CMS fee schedule, and postoperative care within that timeframe is included.

When performed in conjunction with other major gynecologic procedures (e.g., laparoscopic hysterectomy), review NCCI edits to ensure accurate coding. Use modifier 59 (or XS) only if the procedures are distinct and separately documented.

Prior authorization is commonly required by payers for surgeries related to prolapse, especially those involving mesh.

CPT 57420 - Reimbursement Information 

CPT 57420 remains listed under major laparoscopic reconstructive gynecologic procedures. Due to the combined nature of the repair, it generally reimburses more than CPT 57415.

Key billing points:

• Global period: 90 days
• Multiple procedure reduction: Applies when billed with other major procedures
• Site of service: Hospital or ASC setting
• Prior authorization: Frequently required by commercial plans

Reimbursement varies across regions and payers; verify each payer’s policy before claim submission.

Modifiers For CPT 57420

Use modifiers as appropriate to clarify procedural intent:

• Modifier 59 (or XS): Separate, distinct service during the same operative session.
• Modifier 51: When multiple unrelated procedures are performed.
• Modifier 54 / 55: For division of intraoperative and postoperative management.
• Modifier 52: When the service is reduced or incomplete.

Laterality modifiers are not used for this procedure.

Documentation Requirements

Comprehensive documentation ensures accurate coding and reimbursement. Include the following elements in the operative note:

• Preoperative and postoperative diagnoses (vaginal prolapse, enterocele).
• Confirmation of the laparoscopic approach.
• Detailed repair technique for the enterocele sac.
• Identification of the fixation site for vaginal suspension.
• Type of material used (mesh or sutures).
• Intraoperative findings and concurrent procedures.
• Postoperative management and follow-up instructions.

Thorough notes demonstrate medical necessity and protect against audit issues.

Example Scenarios

Scenario 1:

A patient with post-hysterectomy vaginal vault prolapse and enterocele undergoes laparoscopic colpopexy with sac closure. → Report CPT 57420.

Scenario 2:

Laparoscopic hysterectomy performed with separate, fully documented enterocele repair and vault suspension. → Report hysterectomy code + 57420 with modifier 59.

Scenario 3:

Laparoscopic colpopexy without enterocele repair. → Report CPT 57415.

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