2025 HCPCS code S2409

Repair of a congenital malformation of the fetus, performed in utero.

This code is for use by private payers and Medicaid. It is not payable by Medicare. Use this code when a more specific code is not available. Ensure that the documentation clearly supports the use of this code.

Modifiers may be applicable depending on payer requirements and specific circumstances of the procedure. Refer to payer-specific guidelines for modifier usage.

Medical necessity must be established for all procedures billed with S2409. This typically involves demonstrating that the fetal intervention is necessary to improve the outcome for the fetus. Payer-specific policies regarding medical necessity should be consulted.

The physician performing the in utero repair is responsible for selecting the appropriate code and providing sufficient documentation to support the procedure. Documentation should clearly identify the congenital malformation and detail the steps taken to repair it.

IMPORTANT Consider other S codes (S2400-S2405) for specific in utero repairs. CPT codes may be applicable if specific components of the procedure are separately billable.

In simple words: This code is used for a procedure to fix a birth defect in a baby still in the womb, when there isn't a more specific code for what was done.

This code describes a procedure performed to repair a congenital malformation in a fetus within the uterus, when the specific procedure is not otherwise classified in the HCPCS code set.

Example 1: A fetus is diagnosed with a congenital diaphragmatic hernia. A fetoscopic procedure is performed to repair the defect in utero. As this specific procedure is not otherwise classified, S2409 is used., A fetus is diagnosed with a myelomeningocele. An open fetal surgery procedure is performed to close the defect. As this specific procedure is not otherwise classified, S2409 is reported., A twin-to-twin transfusion syndrome is diagnosed. Fetoscopic laser ablation of placental anastomoses is performed, which would be reported separately. However, additional repair work is performed not covered by other codes. S2409 may be applicable for the additional repair.

Documentation must support the medical necessity of the procedure. The specific congenital malformation should be clearly documented, including imaging findings. Operative reports should detail the techniques used for the repair.

** S codes are used by private payers and Medicaid to implement policies and programs, and for claims processing. While some S codes correspond to procedures reportable with CPT codes, S codes may offer a more comprehensive way to represent complex procedures, as they can encompass all components of a procedure under a single code.

  • Payment Status: Not payable by Medicare.
  • Specialties:Maternal-Fetal Medicine, Pediatric Surgery, Fetal Surgery
  • Place of Service:Inpatient Hospital
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