2025 HCPCS code S2404
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgical Procedure - Congenital Defect Repair (In Utero) Miscellaneous Provider Services and Supplies Feed
In utero repair of fetal myelomeningocele.
Modifiers may be necessary to specify the circumstances under which the procedure was performed.Consult the HCPCS coding guidelines and payer-specific requirements for the appropriate modifier selection.
Medical necessity is established based on the severity of the fetal myelomeningocele and its potential impact on the infant’s neurological function.Pre-operative evaluation and risk assessment are crucial to determine the need for the intervention. Documentation should clearly demonstrate the severity of the defect and the potential benefits of the surgery compared to the risks.
The clinical responsibility rests with the surgeon performing the in utero fetal surgery.This includes pre-operative assessment, surgical planning, execution of the procedure, post-operative monitoring, and follow-up care.
In simple words: This code describes a surgery to fix a birth defect in a baby while it's still in the mother's womb. The baby has a problem with its spinal cord and covering, and this surgery repairs it.
This HCPCS code, S2404, represents the surgical repair of a fetal myelomeningocele performed in utero.Myelomeningocele is a severe congenital neural tube defect where the spinal cord and meninges protrude through an opening in the spine.The procedure involves a minimally invasive surgical approach to access the fetus within the uterus and correct the defect, followed by closure of the uterine incision.This is a complex procedure requiring specialized surgical expertise and equipment.
Example 1: A 28-week pregnant patient is diagnosed with a myelomeningocele in her fetus.The surgical team performs an in utero repair using S2404.Post-operative monitoring includes regular ultrasounds and fetal heart rate monitoring., A 24-week pregnant patient presents with a large myelomeningocele.Due to the size and complexity, the surgical team uses S2404, along with additional codes to capture related services such as ultrasound guidance and other intrauterine procedures., A 30-week pregnant patient is found to have a small myelomeningocele and undergoes an in utero repair using S2404.This was a relatively uncomplicated procedure with no major post-operative complications.
Comprehensive prenatal ultrasound images demonstrating the myelomeningocele, operative report detailing the surgical technique and any complications, post-operative ultrasound and fetal monitoring records, and any necessary pathology reports.
** This code is specific to in utero repair of myelomeningocele.Other congenital anomalies may require different codes within the S2400-S2409 range or other relevant codes. Always refer to the most current payer guidelines and coding manuals to ensure accurate coding and billing.
- Revenue Code: Revenue codes will vary depending on the payer and place of service.
- RVU: RVUs are not applicable for this HCPCS code as it is not payable by Medicare.Payment varies based on payer contracts and local guidelines.
- Global Days: Not applicable.Global surgical periods generally do not apply to this type of procedure.
- Payment Status: Active (but not payable by Medicare)
- Modifier TC rule: Not applicable. Technical component modifiers are not usually applied to HCPCS codes.
- Fee Schedule: Not applicable as this is a non-Medicare code and reimbursement is handled by private payers.
- Specialties:Fetal surgery, maternal-fetal medicine, obstetrics, neonatology.
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center