Summary & Overview
HCPCS Level II S2265: Induced Abortion, 25 to 28 Weeks
HCPCS Level II code S2265 denotes an induced abortion performed at 25 to 28 weeks’ gestation. This code captures later-term procedural care that typically requires comprehensive clinical resources, anesthesia, and an appropriate facility setting. Nationally, services represented by S2265 are clinically significant due to higher complexity and resource intensity compared with earlier-term terminations, and they are subject to varied payer coverage policies and clinical protocols.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national view of how this service is categorized and billed, contextual clinical notes on the procedure and typical sites of care, and a summary of payer coverage considerations. The publication highlights benchmarks and coding practice points, summarizes relevant policy updates where available, and explains implications for billing workflows and claims adjudication.
The content is intended for billing managers, revenue cycle staff, clinical coders, and policy analysts seeking concise guidance on handling HCPCS Level II code S2265 in a national context. Data not provided in the source input are identified as unavailable.
Billing Code Overview
HCPCS Level II code S2265 describes induced abortion, 25 to 28 weeks. This service typically involves a medically induced termination of pregnancy performed during the second to early third trimester. The service type is a procedural obstetric/gynecologic intervention. The typical site of service is an inpatient hospital or an ambulatory surgical center that can provide the necessary clinical support and anesthesia for a later-term termination.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 26-year-old pregnant person at 26 weeks gestation presents to a hospital-based women's services unit seeking an induced termination of pregnancy for severe fetal anomaly confirmed on ultrasound and fetal MRI. Pre-procedure workflow includes informed consent, review of maternal medical history, Rh typing and administration of Rho(D) immune globulin if Rh-negative, ultrasound to confirm gestational age and fetal presentation, pre-anesthesia evaluation, and counseling about risks including hemorrhage and infection. The procedure is performed in an operating room or procedure suite under regional or general anesthesia with obstetric/gynecologic surgical staff, anesthesia providers, and nursing. Post-procedure monitoring occurs in the post-anesthesia care unit with assessment of vital signs, uterine tone, bleeding, pain control, and infection prevention; follow-up includes contraception counseling and a postoperative visit to evaluate recovery and any complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for an induced abortion at 25–28 weeks (e.g., significant adhesions or complexity). |
23 | Unusual anesthesia |