2025 HCPCS code S2265
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Procedure - Temporary National Codes (Non-Medicare) Miscellaneous Provider Services and Supplies Feed
Induced abortion between 25th and 28th week of gestation for maternal or fetal indications.
Modifiers may apply depending on the circumstances, such as the location of service or anesthesia use. Consult specific payer guidelines for appropriate modifier usage.
Medical necessity for late-term abortion is typically established based on severe maternal or fetal complications posing immediate risk to the mother's life or severe fetal anomaly incompatible with life.Documentation must clearly support the medical justification for the termination of pregnancy. Specific payer policies will dictate additional requirements.
The provider is responsible for administering abortion-inducing medication or prostaglandins and potentially performing a surgical evacuation of retained products of conception if necessary.This requires expertise in obstetrics and gynecology and potentially surgical skills.
- Miscellaneous Provider Services and Supplies
- S0012-S9999 > Miscellaneous Provider Services and Supplies > S0630-S3722
In simple words: The doctor performs an abortion between the 25th and 28th week of pregnancy because of problems with the mother's or baby's health.This might involve medication or injections to induce labor, and in some cases, surgery to remove remaining tissue.
The provider induces an abortion between the 25th and 28th week of gestation for maternal or fetal indications. The provider administers an abortion-inducing medication, such as misoprostol or a combination of misoprostol and mifepristone, either vaginally or sublingually. Alternatively, the provider administers prostaglandins vaginally at three-to-six-hour intervals to induce abortion.For heavy vaginal bleeding, the patient may require surgical evacuation of retained products of conception.
Example 1: A 27-year-old woman presents with severe preeclampsia at 26 weeks gestation, posing a significant threat to her life.The provider performs an abortion (code S2265) due to maternal medical necessity., A 25-year-old woman at 27 weeks gestation experiences fetal demise confirmed by ultrasound.The provider performs an abortion (code S2265) to manage the pregnancy loss., A 28-year-old pregnant woman at 28 weeks gestation develops a severe fetal anomaly incompatible with life, confirmed through fetal imaging.The provider performs an abortion (code S2265) for fetal indications.
Detailed patient history, including reason for abortion (maternal or fetal indications), gestational age at the time of the procedure, documentation of the method used (medication, prostaglandins, or surgical evacuation), and any complications encountered.Ultrasound reports or fetal imaging to confirm gestational age and fetal condition, as well as any relevant laboratory results (e.g., blood work related to pre-eclampsia).Consent forms for the procedure.
** This code is not reimbursable by Medicare. Check with your payer for their specific reimbursement guidelines.This code is for late-term abortions and should not be used for early-term abortions.Detailed documentation is critical to support medical necessity and proper reimbursement.
- Payment Status: Active (Non-Medicare)
- Modifier TC rule: The applicability of TC modifiers would depend on the services performed, particularly if a surgical component is involved.
- Fee Schedule : Unknown.Fee schedules vary widely by payer and geographic location.This HCPCS code is non-Medicare, so reimbursement is dependent on the private payer.
- Specialties:Obstetrics and Gynecology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center