CPT Code 57454 Colposcopy with Biopsy and Endocervical Curettage

Accurate CPT coding in gynecologic procedures ensures compliance, prevents denials, and supports proper reimbursement. CPT 57454 describes a colposcopy of the cervix and upper/adjacent vagina with biopsy and endocervical curettage (ECC). It is commonly performed after abnormal Pap smear or HPV test results to evaluate and sample cervical or vaginal lesions.

This 2025 coding guide outlines CPT 57454 based on the latest AAPC and CMS standards, including when to report it, documentation requirements, modifier usage, and reimbursement insights for OBGYN providers.

CPT 57454 – Description

Official Definition: “Colposcopy of the cervix, including upper/adjacent vagina, with biopsy(s) of the cervix and endocervical curettage.”

This code covers a diagnostic and minor therapeutic procedure performed under colposcopic visualization. It includes:

• Magnified examination of the cervix and upper vagina.
• Targeted cervical biopsy or biopsies.
• Endocervical curettage (ECC) to sample the endocervical canal.

It is more extensive than a simple colposcopy with ECC (CPT 57456) and less extensive than a loop excision or cone biopsy (CPT 57522).

When to Use CPT 57454

Use CPT 57454 when a colposcopic examination is performed and both a cervical biopsy and endocervical curettage are completed in the same session.

Common clinical indications:

• Abnormal Pap smear (ASC-H, HSIL, LSIL, AGC, etc.)
• Positive HPV test for high-risk types.
• Visualization of suspicious cervical or vaginal lesions.
• Post-treatment surveillance for cervical dysplasia.
• Unexplained postcoital or intermenstrual bleeding with abnormal cervical findings.

Do not report 57454 when:

• Only ECC is performed (use 57505).
• Only a biopsy under colposcopy is done without ECC (57454 requires both).
• Loop excision or conization is performed (use 57522).

Coding Guidelines

Per CMS 2025 global surgical rules, CPT 57454 includes:

• Cervical and vaginal inspection under colposcopy.
• Targeted biopsy collection.
• Endocervical curettage (ECC).

It has a 10-day global period (minor procedure) and should not be reported separately for ECC or simple colposcopy.

If multiple biopsies are performed, they are included within a single CPT 57454 charge — do not bill multiple units.

If the colposcopy is extended to include the vulva, use CPT 57452 in addition only if medically necessary and properly documented as a distinct service (typically with modifier 59).

Reimbursement Information

Medicare and Commercial Payers (2025):

• Average physician reimbursement: ~$140–$180 (depending on region).
• Site of service: Outpatient or office setting.
• Global period: 10 days.
• Multiple procedure reduction: Not typically applicable.

For Medicare patients, CPT 57454 is subject to standard ASC and office-based reimbursement rules. Payers may require specific diagnosis codes (ICD-10-CM) that justify medical necessity, such as N87.0–N87.9 (Cervical dysplasia), R87.610–R87.619 (Abnormal Pap test), or A63.0 (HPV-related lesions).

Always verify payer-specific LCDs (Local Coverage Determinations) or medical policies before billing.

Applicable Modifiers

Use appropriate modifiers to define procedural context and responsibility:

• Modifier 25: If performed during the same session as an unrelated E/M service.
• Modifier 59 (or XU): If an additional colposcopic site (e.g., vulva) is evaluated separately.
• Modifier 51: For multiple procedures in one session (if applicable).
• Modifier 26 / TC: Only if the provider bills separately for professional or technical components (rare in office settings).

Avoid modifier use unless supported by clinical documentation.

Documentation Requirements

Detailed documentation supports medical necessity and accurate coding. The provider’s note must include:

• Indication for colposcopy (abnormal Pap, positive HPV, visible lesion, etc.).
• Colposcopic findings: acetowhite areas, mosaicism, punctation, vascular changes.
• Location and number of biopsies taken.
• Endocervical curettage (ECC) was performed, and findings were noted.
• Pathology specimens were labeled and sent for analysis.
• Patient counseling and follow-up recommendations.

Ensure operative or procedure notes clearly reflect that both biopsy and ECC were completed.

Example Scenarios

Scenario 1:

A patient presents after an abnormal Pap smear (HSIL). The OBGYN performs a colposcopic exam, takes targeted cervical biopsies, and performs ECC. → Report CPT 57454.

Scenario 2:

Colposcopy performed for an abnormal Pap test, biopsy taken, but ECC omitted. → Report CPT 57454 is not appropriate; use CPT 57454 only when ECC is performed.

Scenario 3:

During an established visit, an abnormal lesion is identified, and the physician performs colposcopy with biopsy and ECC during the same encounter. → Report 57454 + Modifier 25 for the E/M service.

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