HCPCS S2400: Fetal Repair of Congenital Diaphragmatic Hernia with Tracheal Occlusion

HCPCS Level II code S2400 designates an in utero procedure to repair congenital diaphragmatic hernia (CDH) using temporary tracheal occlusion. This fetal surgical intervention aims to promote lung growth and improve neonatal outcomes for severe CDH cases. The code captures a highly specialized, resource-intensive service that is concentrated at tertiary fetal surgery centers and has implications for surgical, maternal-fetal medicine, and neonatology teams.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of clinical context and billing considerations tied to this procedure, including expected sites of service and the specialized nature of care. The publication outlines benchmarks where available, summarizes relevant policy or coverage themes that commonly affect high-acuity fetal interventions, and explains the coding context for payer negotiations and claim adjudication.

The content is intended to help billing managers, revenue cycle professionals, and clinical program leads understand how S2400 fits into service line planning and payer engagement for fetal surgery programs. Data not available in the input will be noted where applicable.

Billing Code Overview

HCPCS Level II code S2400 describes the in utero repair of congenital diaphragmatic hernia using temporary tracheal occlusion. The procedure is performed on the fetus to address pulmonary hypoplasia and improve fetal lung development prior to birth.

Service Type: Fetal surgery / Maternal-fetal interventional procedure

Typical Site of Service: Hospital-based tertiary care center or specialized fetal surgery center (operating room or surgical suite within a hospital)

Clinical Context

A pregnant patient at 24–30 weeks gestation is referred to a maternal-fetal medicine (MFM) program after prenatal imaging (high-resolution ultrasound and fetal MRI) demonstrates a large, left-sided congenital diaphragmatic hernia (CDH) with liver herniation and severe pulmonary hypoplasia risk. The multidisciplinary team includes MFM, pediatric surgery, neonatology, and anesthesiology. After counseling and review of fetal and maternal risks, the team elects to perform fetal repair via temporary tracheal occlusion (FETO) in utero to promote lung growth.

Procedure workflow:

Initial evaluation: detailed ultrasound, fetal echocardiography, fetal MRI, maternal labs, and consent discussions.
Preprocedure: maternal anesthesia planning, administration of prophylactic antibiotics and tocolysis as indicated, and ultrasound-guided fetal positioning.
Procedure: under maternal regional or general anesthesia, endoscopic fetoscopic insertion of a balloon device is performed and positioned in the fetal trachea to temporarily occlude the airway, stimulating lung growth. Imaging confirmation of balloon placement is obtained.
Postprocedure: maternal observation, ultrasound assessments to confirm balloon position and absence of immediate complications (e.g., preterm premature rupture of membranes, bleeding), and scheduled follow-up visits with serial imaging to monitor fetal lung growth.
Delivery planning: multidisciplinary delivery at a tertiary care center with immediate neonatal surgical-capable team prepared for balloon removal (if not spontaneously dislodged) and postnatal CDH repair planning.

Typical site of service: tertiary care hospital with maternal-fetal medicine and pediatric surgery/fetal surgery capabilities, operating room or specialized fetal intervention suite.

Typical patient scenario: a singleton pregnancy in the mid-second to early third trimester with sonographic and MRI confirmation of severe CDH and predicted poor pulmonary development, where temporary fetal tracheal occlusion is offered after multidisciplinary risk–benefit discussion.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when the full planned fetoscopic procedure could not be completed or a partial intervention was performed.
`53`	Discontinued procedure	Use if the fetal tracheal occlusion procedure was started but terminated due to intraoperative maternal or fetal complication.
`59`	Distinct procedural service	Use when reporting other distinct fetal or maternal procedures on the same day that are not normally reported together.
`62`	Two surgeons	Use when two surgeons of different specialties (e.g., MFM and pediatric surgeon) perform distinct portions of the procedure.
`76`	Repeat procedure by same physician	Use for a repeat FETO attempt by the same physician during the same pregnancy.
`77`	Repeat procedure by another physician	Use for a repeat FETO attempt by a different physician.
`66`	Surgical team approach	Use when a surgical team billing arrangement is required for complex fetal surgery requiring multiple surgeons.
`74`	Discontinued outpatient hospital/ambulatory surgery facility procedure prior to anesthesia	Use if the procedure was cancelled after patient preparation but before anesthesia induction.
`91`	Repeat clinical diagnostic test	Use when repeat ultrasound or fetal imaging is performed intra- or post-procedure for immediate confirmation (billing for repeat diagnostic test services).
`99`	Multiple modifiers — expanded	Use when nonstandard or multiple informational modifiers are required by the payer to describe unique circumstances (verify payer acceptance).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for covered anesthesia	Use when advanced practice providers bill for anesthesia-related services per payer rules.
`QX`	CRNA service with physician absence (modifier QX)	Use when a certified registered nurse anesthetist provides anesthesia without a physician anesthesiologist present, where allowed.

Taxonomy Code	Specialty	Notes
207L00000X	Maternal-Fetal Medicine (MFM)	Subspecialist in high-risk obstetrics who performs or leads fetal interventions.
2080P0207X	Pediatric Surgery	Surgeon specializing in neonatal and fetal surgical procedures, often present for postnatal planning and intraoperative collaboration.
207LP2900X	Obstetrics & Gynecology	General OB/GYN involved in maternal care and perioperative management for fetal procedures.
2084P0800X	Pediatric Cardiac Surgery (if cardiac anomaly present)	Consulted when fetal cardiac anomalies or hemodynamic concerns accompany CDH.
363LP0800X	Neonatal-Perinatal Medicine	Neonatologist involved in delivery planning and immediate postnatal care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q79.0`	Congenital diaphragmatic hernia	Primary indication for fetal tracheal occlusion to promote lung growth in severe cases.
`O30.8XX0`	Multiple gestation status, unspecified (example if twin pregnancy)	Relevant when considering fetal intervention in multiples; affects candidate selection and approach.
`P07.3`	Preterm newborn, gestational age 28 completed weeks or less	Relevant as a potential postprocedure outcome risk; fetal interventions can increase preterm birth risk.
`O42.0`	Premature rupture of membranes, onset before 37 completed weeks, before 28 completed weeks	Possible maternal/fetal complication after invasive fetal procedures.
`Q20.8`	Other congenital malformations of heart	Associated anomalies that may influence candidacy and perinatal planning for fetal intervention.
`Z3A.24`	24 weeks gestation of pregnancy	Gestational age codes are used to document timing of the procedure and relate to CMS/payer medical necessity determinations.
`Z33.1`	Pregnant state	Administrative code used in pregnancy-related procedural billing and records.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`59840`	Salpingostomy, cesarean delivery or hysterotomy for fetal intervention (example code for open fetal intervention-related uterine entry)	May be used if a hysterotomy/cesarean approach is performed for access in select fetal procedures; not typical for fetoscopic FETO but relevant to open fetal surgery workflows.
`58356`	Fetoscopy, diagnostic or therapeutic, including amnioscopy when performed	Represents endoscopic fetoscopic approaches; used when fetoscopic visualization and instrumentation are performed for tracheal occlusion.
`36591`	Insertion of non-tunneled centrally inserted central venous catheter, neonatal and pediatric	Used when central venous access is required for neonatal postoperative management rather than for the fetal procedure itself; included here as part of perinatal planning.
`76937`	Ultrasound guidance for needle placement (eg, for amniocentesis, fetal procedures)	Used for ultrasound guidance during needle or trocar placement in fetoscopic tracheal occlusion.
`00530`	Anesthesia for procedures on the lower abdomen (includes uterus)	Anesthesia codes applicable to maternal anesthesia management during fetal intervention.
`76811`	Ultrasound, pregnant uterus, fetal and maternal assessment, follow-up study	Used for pre- and postprocedure fetal imaging assessments to evaluate lung growth and balloon position.

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Summary & Overview