Summary & Overview
HCPCS Level II S2402: In Utero Repair of Congenital Cystic Adenomatoid Malformation
HCPCS Level II code S2402 denotes repair of congenital cystic adenomatoid malformation in the fetus performed in utero. This code captures a highly specialized fetal surgical procedure intended to treat congenital pulmonary airway malformations before birth to reduce fetal compromise and improve neonatal respiratory outcomes. Nationally, such fetal interventions are rare but clinically significant because they require specialized multidisciplinary teams, tertiary referral centers, and specific payer coverage policies that affect access and authorization pathways.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how the code is used in clinical billing, typical sites of service, common modifiers and billing considerations, and how major payers approach coverage and prior authorization for high-acuity fetal surgery. The publication also outlines benchmarking considerations for utilization, coding documentation requirements, and relevant policy trends that influence reimbursement and access. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code S2402 describes repair of congenital cystic adenomatoid malformation in the fetus, performed in utero. This procedure is an intrauterine fetal surgical intervention aimed at correcting a congenital pulmonary airway malformation (also called congenital cystic adenomatoid malformation) before birth to address fetal compromise or anticipated postnatal respiratory problems.
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Service type: In utero fetal surgical repair
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Typical site of service: Hospital-based tertiary care centers with maternal-fetal medicine and fetal surgery capabilities, often in operating rooms or specialized fetal intervention suites
Clinical & Coding Specifications
Clinical Context
A pregnant patient at 24–28 weeks gestation is referred to a maternal-fetal medicine (MFM) program after routine ultrasound demonstrates a large congenital pulmonary airway malformation (formerly congenital cystic adenomatoid malformation) occupying a significant portion of the fetal thorax with mediastinal shift and progressive hydrops fetalis. The multidisciplinary clinical workflow includes: prenatal imaging with targeted fetal ultrasound and fetal MRI to assess lesion size and vascularity; serial ultrasound surveillance for progression and development of hydrops; fetal echocardiography to evaluate cardiac compromise; maternal counseling by MFM, pediatric cardiothoracic surgery, neonatology, and ethics; and review of candidacy for in utero intervention. When fetal compromise (progressive hydrops, severe mass effect, or risk of fetal demise) is present, an in utero surgical team performs fetal thoracoscopic or open fetal repair to resect or decompress the lesion under maternal anesthesia with continuous fetal monitoring. The procedure is typically performed in a hospital operating room or specialized fetal surgery suite with neonatal intensive care unit (NICU) and blood bank available. Post-procedure care includes maternal recovery, serial fetal surveillance, and planned delivery at a tertiary center with pediatric surgery and NICU support.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when intrauterine repair required substantially greater work or complexity than typical. |