CPT Code 57522 Excision Procedures on the Cervix Uteri

Coding for cervical excision procedures is essential for OBGYN practices to ensure clinical accuracy, maintain compliance, and achieve full reimbursement. CPT 57522 represents an extensive conization of the cervix, typically performed to treat severe dysplasia, adenocarcinoma in situ, or microinvasive carcinoma. This advanced excision removes a larger cone of cervical tissue than standard conization, demanding detailed documentation and correct code selection.

This guide explains AAPC and CMS 2025 updates for CPT 57522, focusing on accurate reporting, modifier application, and documentation requirements tailored for OBGYN providers.

CPT 57522 – Description

Official Definition: “Conization of cervix, extensive, 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 an extensive surgical excision of the cervix that extends deeper or wider than a standard cone biopsy. It is typically indicated for patients in whom prior biopsies or limited excisions revealed severe precancerous or early malignant disease.

Key characteristics:

• The excision is larger and deeper than CPT 57520.
• May involve endocervical canal and lateral vaginal fornices.
• Includes simple repair and hemostasis, when performed.
• Specimens are submitted for pathologic margin evaluation.

When to Use CPT 57522

Report CPT 57522 when performing an extensive cervical excision for diagnostic or therapeutic purposes. Common indications include:

• Adenocarcinoma in situ (AIS) or microinvasive carcinoma.
• High-grade squamous intraepithelial lesion (HSIL) with endocervical involvement.
• Persistent CIN 3 after prior conization or LEEP.
• Non-diagnostic or positive-margin specimens from previous excisions.
• Need for complete removal of the transformation zone with deep endocervical extension.

Do not use CPT 57522 for:

• Standard-depth conization (use 57520).
• Loop or electroexcisional methods (use 57460/57461).
• Radical trachelectomy or hysterectomy (use surgical oncology codes).

Coding Guidelines and Compliance For CPT Code 57522

As per CMS and AAPC 2025 guidance:

• Report CPT 57522 once per operative session.
• Includes simple repair, fulguration, and D&C when performed concurrently.
• Carries a 90-day global period covering postoperative follow-ups.
• Document the extent of excision, margin orientation, and closure technique.
• Do not separately report pathology or anesthesia services.
• Use appropriate modifiers only when procedures are distinct or unrelated.

CPT 57522 - Reimbursement Overview 

CPT 57522 – 2025 Payment Data

• Global period: 90 days
• Typical setting: Hospital / Ambulatory Surgical Center
• Average Medicare reimbursement: ~$900 – $1,050 (region-specific)
• ASC facility payment: ~$550 – $650

Commercial payers often require prior authorization and pathology confirmation for high-risk or repeat excisional procedures. Documentation of medical necessity must clearly justify the extent of the excision.

Modifier Guidance - CPT 57522

Use modifiers accurately to reflect the scope and circumstances of the service:

• Modifier 22: For unusually complex conization due to anatomic distortion or bleeding risk.
• Modifier 51: If performed with another major gynecologic procedure.
• Modifier 59 / XU: For distinct procedural services performed in the same session.
• Modifier 54 / 55: To split surgical and postoperative management.
• Modifier 26 / TC: For professional or technical component separation in facility billing.

Improper modifier selection may lead to denials or compliance audits.

Documentation Essentials

To support CPT 57522 billing, operative notes should clearly outline:

• Indication: AIS, HSIL, or early invasive carcinoma.
• Procedure details: Cold-knife or laser technique, anesthesia, and positioning.
• Extent of excision: Measurements, depth, and margins.
• Hemostasis method: Fulguration, suturing, or cautery.
• Specimen orientation: Stitch markers or inked margins for pathology.
• Intraoperative findings: Lesion extent and margin visualization.
• Postoperative plan: Recovery guidance and follow-up interval.

Accurate, detailed documentation ensures compliance with 2025 CMS audit standards and validates medical necessity for reimbursement.

Example Scenarios

Scenario 1:

A 40-year-old patient with adenocarcinoma in situ undergoes deep cold-knife conization extending into the endocervical canal. → Report CPT 57522.

Scenario 2:

Repeat conization performed due to positive margins after a prior LEEP. → Report CPT 57522.

Scenario 3:

Standard conization for CIN 3 without deep extension. → Report CPT 57520.

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