CPT Code 57505 Excision Procedures on the Cervix Uteri

Accurate CPT coding is crucial for OBGYN practices to ensure compliance, prevent claim denials, and secure proper reimbursement. CPT 57505 is used for endocervical curettage (ECC), a procedure that collects tissue from the endocervical canal for histologic evaluation. This is typically performed when abnormal cervical cytology, high-risk HPV, or colposcopic findings suggest glandular or endocervical pathology.

This guide provides a detailed overview of CPT 57505 usage, documentation, reimbursement, and modifier application, in accordance with AAPC and CMS 2025 standards, to support accurate OBGYN medical billing.

CPT 57505 – Description

Official Definition: “Endocervical curettage, diagnostic, with or without colposcopy.”

CPT 57505 involves scraping the endocervical canal using a curette or cytobrush to obtain tissue samples for histologic examination. The procedure is diagnostic only and does not include colposcopic biopsy of the cervix or loop excision, which are reported with separate CPT codes (57454, 57456, 57460).

Key distinctions:

• Focuses exclusively on tissue from the endocervical canal.
• May be performed with or without colposcopic guidance.
• Separate codes are required for therapeutic excisions or cervical biopsies.

When to Use CPT 57505

CPT 57505 should be reported when performing ECC for diagnostic evaluation of endocervical pathology. Common clinical indications include:

• Unsatisfactory visualization of the transformation zone.
• Abnormal cytology with atypical glandular cells (AGC).
• Follow-up after an abnormal Pap smear or previous cervical procedures.
• High-risk HPV positivity with suspicion of endocervical dysplasia.
• Surveillance after treatment for CIN or cervical cancer.

Do not report CPT 57505 for:

• Colposcopic biopsies of the ectocervix (use 57454).
• Loop or cone excision procedures (use 57460, 57461, 57522).
• Simple visual examination without tissue collection (use 57452).

Coding Guidelines and Compliance (2025 Update)

Per AAPC and CMS 2025 guidance:

• Report once per session, even if multiple passes are taken to collect sufficient endocervical tissue.
• When performed during colposcopy, do not separately report colposcopy if it is included in the diagnostic evaluation.
• The procedure carries a 10-day global period, encompassing routine follow-up visits.
• Documentation must clearly indicate medical necessity, including abnormal cytology, HPV positivity, or prior treatment history.
• Modifier use should be limited to situations where multiple distinct procedures are performed concurrently.

Reimbursement Overview

CPT 57505 – 2025 Payment Data

• Global period: 10 days
• Typical setting: Office or outpatient clinic
• Average Medicare reimbursement: ~$120–$150 (varies by region)
• ASC payment: Often bundled with pathology services

Commercial payers may require supporting cytology results or prior abnormal Pap/HPV tests to justify ECC. Pre-authorization might be necessary for some in-office procedures.

Modifier Guidance

Correct modifier usage ensures accurate reimbursement:

• Modifier 25: When a significant, separately identifiable E/M service is performed on the same day.
• Modifier 51: For multiple procedures performed at the same session.
• Modifier 59 (or XU): To indicate a distinct procedural service in addition to unrelated procedures.
• Modifier 26 / TC: Used to separate professional and technical components in facility billing.

Avoid applying modifiers unnecessarily, as this can lead to claim denials or payer audits.

Documentation Essentials

Comprehensive documentation is critical to support coding and reimbursement:

• Clinical indication: Abnormal Pap, HPV positive, AGC, or surveillance following cervical treatment.
• Procedure details: Technique, instrument type, and number of passes used to obtain endocervical tissue.
• Findings: Description of any abnormalities observed in the endocervical canal.
• Specimen handling: Confirmation that tissue was submitted for pathology.
• Follow-up instructions: Recommendations for subsequent visits or additional testing.

Accurate notes protect against denials and ensure compliance with 2025 CMS audit expectations.

Example Scenarios

Scenario 1:

A 40-year-old patient with AGC on Pap smear undergoes endocervical curettage without cervical biopsy. → Report CPT 57505.

Scenario 2:

Endocervical curettage is performed alongside a cervical loop excision. → Report CPT 57460/57461 for loop excision; do not separately report ECC.

Scenario 3:

Colposcopy with cervical biopsy only, without ECC. → Report CPT 57454.

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