CPT Code 57520 Excision Procedures on the Cervix Uteri

Accurate procedural coding is essential for OBGYN practices to maintain compliance, support clinical integrity, and ensure timely reimbursement. CPT 57520 describes the conization of the cervix, a surgical procedure in which a cone-shaped section of cervical tissue is excised to diagnose or treat precancerous or early malignant lesions.

This guide outlines the latest 2025 coding, documentation, and reimbursement standards from AAPC and CMS, helping OBGYN providers code CPT 57520 correctly and reduce payer denials through accurate reporting.

CPT 57520 – Description

Official Definition: “Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser.”

This code applies when the physician performs a surgical excision of a cone-shaped portion of the cervix, encompassing part or all of the transformation zone and endocervical canal. The procedure may be performed using a scalpel (cold knife) or laser excision technique.

Key distinctions:

• CPT 57520 is used for surgical excision, not ablative or loop techniques (use 57460 or 57461 for LEEP).
• May include D&C or fulguration if performed during the same operative session.
• The specimen is typically sent for pathologic evaluation to confirm diagnosis or margin status.

When to Use CPT 57520

Report CPT 57520 when a diagnostic or therapeutic conization is required to evaluate or treat suspected or confirmed cervical pathology. Common clinical indications include:

• High-grade squamous intraepithelial lesion (HSIL/CIN 2 or CIN 3).
• Atypical glandular cells (AGC) or adenocarcinoma in situ (AIS).
• Positive endocervical curettage or unsatisfactory colposcopy.
• Suspicion of microinvasive carcinoma.
• Persistent or recurrent dysplasia after previous treatment.

Do not report CPT 57520 if:

• A loop or electroexcisional technique is used (use 57460/57461).
• The procedure involves total or radical excision (use 57522).
• Only biopsy or ablation is performed (use 57454 or 57511).

Coding Guidelines and Compliance

Per AAPC and CMS 2025 coding policies:

• Report CPT 57520 once per operative session, regardless of how many specimens are obtained.
• The code includes simple repair and D&C, when performed concurrently.
• The procedure carries a 90-day global period, encompassing all related postoperative visits.
• Pathology review should be referenced in documentation but billed separately using pathology CPT codes (88305, etc.).
• Ensure the operative note details the technique, lesion extent, margins, and hemostasis method.
• Use modifiers appropriately if multiple unrelated services are performed.

Reimbursement Overview

CPT 57520 – 2025 Payment Data

• Global period: 90 days
• Typical setting: Hospital or ambulatory surgical center (ASC)
• Average Medicare reimbursement: ~$700–$850 (region-dependent)
• ASC facility payment: ~$450–$500

Commercial payer reimbursement varies based on network contracts and documentation of medical necessity. Some payers require prior authorization for excisional cervical procedures due to their surgical complexity and pathology involvement.

Modifier Guidance

Apply modifiers only when clinically and procedurally justified:

• Modifier 22: For unusually complex conization requiring extended dissection or repair.
• Modifier 51: When performed alongside other major gynecologic surgeries.
• Modifier 59 (or XU): For distinct procedural services during the same operative encounter.
• Modifier 54 / 55: To split global surgical and postoperative management between providers.
• Modifier 26 / TC: For distinguishing professional and technical components in facility billing.

Improper modifier use can trigger audits or reimbursement delays; ensure all applications are clearly supported by documentation.

Documentation Essentials

Detailed operative notes are crucial for compliance and reimbursement. Documentation for CPT 57520 must include:

• Clinical indication: CIN 2/3, AIS, AGC, or suspected malignancy.
• Procedure description: Type of conization (cold knife or laser) and instruments used.
• Extent of excision: Depth, width, and anatomical area involved.
• Hemostasis method: Fulguration, suturing, or cautery details.
• Specimen information: Number of samples, orientation, and confirmation of pathology submission.
• Intraoperative findings: Visual assessment of the transformation zone and margins.
• Postoperative instructions: Recovery plan and follow-up schedule.

Thorough, structured documentation supports medical necessity and strengthens defense against payer audits.

Example Scenarios

Scenario 1:

A 38-year-old patient with CIN 3 undergoes cold knife conization of the cervix with hemostatic sutures. → Report CPT 57520.

Scenario 2:

A patient with adenocarcinoma in situ has a laser conization for diagnostic and therapeutic purposes. → Report CPT 57520.

Scenario 3:

LEEP excision is performed instead of surgical conization. → Report CPT 57460 or 57461, not 57520.

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