CPT Code 57421 Endoscopy/Laparascopy Procedures on the Vagina

Accurate coding of complex laparoscopic pelvic repairs is essential for OBGYN providers to ensure compliance and proper reimbursement. CPT 57421 is used to report a laparoscopic repair of a paravaginal defect, a minimally invasive surgical approach that corrects lateral detachment of the vaginal wall from the pelvic sidewall.

This 2025 billing guide provides a comprehensive overview of CPT 57421, including procedural definition, clinical use, documentation requirements, applicable modifiers, and payer-specific reimbursement considerations, as outlined in the latest AAPC and CMS guidelines.

CPT Code 57421 - Description

Official Definition: “Laparoscopy, surgical, repair of paravaginal defect.”

This procedure involves laparoscopic reattachment of the vaginal wall to the arcus tendineus fascia pelvis or obturator internus fascia to restore normal pelvic anatomy. It is typically performed to treat anterior vaginal wall prolapse (cystocele) caused by a paravaginal fascial defect.

CPT 57421 represents the laparoscopic approach only. If the repair is performed through a vaginal incision, report CPT 57284 instead.

When to Use CPT 57421

Report CPT 57421 when a laparoscopic repair is performed to correct a paravaginal defect that causes loss of anterior vaginal support.

Typical indications include:

• Cystocele secondary to lateral fascial detachment.
• Paravaginal defect following childbirth or prior pelvic surgery.
• Combined pelvic floor prolapse involving lateral vaginal wall separation.
• Recurrent prolapse after prior transvaginal repair.

Do not use 57421 when:

• The repair is done via a vaginal or open abdominal approach.
• The defect is midline rather than lateral (use anterior colporrhaphy code 57240).
• The procedure is limited to suspension of the vaginal apex (use 57415).

Coding and Billing Guidelines For CPT Code 57421

CPT 57421 covers all aspects of the laparoscopic paravaginal defect repair, including dissection, defect identification, and reattachment of the vaginal wall.

The procedure includes a 90-day global period per CMS 2025 guidelines. Postoperative care within this period is bundled into the global payment.

When performed with another major laparoscopic pelvic procedure (e.g., hysterectomy or colpopexy), check NCCI edits for bundling conflicts. Append modifier 59 (or XS) only if the documentation clearly supports that the paravaginal repair is distinct and not part of the primary procedure.

Preauthorization is recommended, as some payers classify laparoscopic paravaginal repair as a reconstructive or complex pelvic floor procedure.

CPT Code 57421 - Reimbursement Information

Under the 2025 Medicare Physician Fee Schedule, CPT 57421 continues to be classified as a major laparoscopic pelvic reconstructive procedure.

It carries higher work RVUs than minor pelvic repairs due to its technical complexity and operative time.

Key billing details:

• Global period: 90 days
• Site of service: Hospital or ambulatory surgical center (ASC)
• Multiple surgery reduction: Applies when performed with other major surgeries
• Prior authorization: Frequently required by commercial payers

Reimbursement varies across payer contracts and geographic regions. Always confirm payer-specific coverage and documentation policies before claim submission.

CPT Code 57421 - Modifiers

Use modifiers only when appropriate to clarify the service rendered:

• Modifier 59 (or XS): Indicates a separate and distinct laparoscopic procedure.
• Modifier 51: For multiple procedures in the same session.
• Modifier 54 / 55: For shared intraoperative and postoperative care.
• Modifier 52: If the procedure is reduced or partially completed.

Laterality modifiers are not applicable, as this code describes repair of a pelvic defect rather than a unilateral site.

Documentation Requirements - CPT 57421

Accurate and detailed operative documentation is essential for medical necessity and audit compliance. The operative note should include:

• Preoperative and postoperative diagnoses (e.g., cystocele, paravaginal defect).
• Confirmation of the laparoscopic approach.
• Identification of defect location (right, left, or bilateral).
• Description of the repair technique and fixation structures.
• Type of sutures or materials used.
• Concurrent procedures, if any.
• Estimated blood loss, intraoperative findings, and closure details.
• Postoperative management plan.

Precise documentation ensures payer recognition of the laparoscopic complexity and supports correct code selection.

Example Scenarios

Scenario 1:

A patient with a right-sided paravaginal defect undergoes laparoscopic dissection and reattachment of the vaginal wall to the arcus tendineus fascia. → Report CPT 57421.

Scenario 2:

During a laparoscopic hysterectomy, a separate paravaginal defect is identified and repaired laparoscopically. → Report hysterectomy code + 57421 with modifier 59.

Scenario 3:

Anterior vaginal wall prolapse repaired via vaginal approach instead of laparoscopic. → Report CPT 57284.

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