HCPCS S2403: Repair of Fetal Extralobar Pulmonary Sequestration, In Utero - OpenPayer

Summary & Overview

HCPCS S2403: Repair of Fetal Extralobar Pulmonary Sequestration, In Utero

HCPCS Level II code S2403 denotes in utero surgical repair of an extralobar pulmonary sequestration, a congenital pulmonary malformation treated before birth. This code captures highly specialized fetal intervention performed in tertiary care centers and is relevant for payers, hospitals, and specialty practices managing complex maternal-fetal care. Nationally, such fetal procedures are uncommon but clinically significant due to their impact on neonatal outcomes, perinatal resource use, and coordination across maternal-fetal medicine, pediatric surgery, and neonatal intensive care.

Key payers in the scope of coverage review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes payer coverage patterns and highlights what readers need to know about billing and clinical context for S2403.

Readers will find: a clear definition of the procedure and typical care setting; an overview of common documentation and service-line considerations; benchmarking context where available; and recent policy or coding considerations that affect authorization and claims processing. If specific payer policy details or diagnosis links are not provided in the input, the report notes that data is not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareS2403HCPCS Level IIfetal surgerypulmonary sequestrationmaternal-fetal medicinepediatric surgeryin utero repairtertiary care

Billing Code Overview

HCPCS Level II code S2403 describes a surgical procedure: repair of extralobar pulmonary sequestration in the fetus, performed in utero. This is an intrauterine fetal surgical repair aimed at correcting a congenital pulmonary vascular and airway malformation prior to birth.

Service Type: Fetal surgical repair / in utero operative procedure

Typical Site of Service: Fetal surgery suite or specialized tertiary care center with maternal-fetal medicine and pediatric cardiothoracic surgery capability

Clinical & Coding Specifications

Clinical Context

A pregnant patient at 22–28 weeks gestation is referred to a fetal surgery center after routine prenatal ultrasound identifies an extralobar pulmonary sequestration (EPS) with progressive mass effect on the fetal thorax and mediastinal shift. Fetal MRI confirms an isolated extralobar bronchopulmonary sequestration with systemic arterial supply and evidence of developing hydrops or compromised lung development. The multidisciplinary team — maternal-fetal medicine specialist, pediatric cardiothoracic surgeon with fetal surgery expertise, anesthesiologist, neonatologist, and nursing staff — evaluates the case. After counseling and informed consent, the patient is admitted for an in utero repair procedure performed in a dedicated operating room or interventional suite equipped for fetal surgery. The procedure involves maternal regional or general anesthesia, ultrasound-guided fetal positioning, surgical access to the fetus (typically fetoscopic or open hysterotomy approach based on lesion size and gestational age), identification of the sequestration and its systemic feeding vessel, and surgical ligation/resection or ablation of the anomalous vessel and sequestrated lung tissue as indicated. Post-procedure monitoring includes maternal recovery, fetal surveillance with ultrasound and fetal heart monitoring, and possible corticosteroid administration to accelerate fetal lung maturity. Delivery planning is adjusted for potential neonatal respiratory support and immediate pediatric surgical or interventional needs. Typical site of service is a tertiary care hospital with a fetal surgery program or specialized maternal-fetal medicine center. Service type is an in utero fetal surgical procedure (fetal therapeutic intervention) for repair of extralobar pulmonary sequestration in the fetus.

Coding Specifications

Modifier	Description	When to Use

HCPCS S8950: Complex Lymphedema Therapy, 15-Minute Unit

HCPCS-S3852-APOE-EPSILON-4-ALLELE-GENETIC-TEST-ALZHEIMERS-SUSCEPTIBILITY

HCPCS S3852: APOE Epsilon 4 Allele DNA Analysis for Alzheimer Susceptibility

HCPCS-S9055-GROWTH-FACTOR-WOUND-HEALING-PREPARATION

HCPCS S9055: Growth Factor Wound Healing Preparation

HCPCS-S0032-NAFCILLIN-2G-INJECTION

HCPCS S0032: Injection, Nafcillin Sodium, 2 g

HCPCS-LEVEL-II-S9991-PHASE-III-CLINICAL-TRIAL-SERVICES

HCPCS Level II S9991: Services for Phase III Clinical Trial

HCPCS-S2115-PERIACETABULAR-OSTEOTOMY-INTERNAL-FIXATION

HCPCS S2115: Periacetabular Osteotomy with Internal Fixation

HCPCS-S4013-COMPLETE-GIFT-CYCLE-GAMETE-INTRAFALLOPIAN-TRANSFER

HCPCS S4013: Complete GIFT Cycle, Gamete Intrafallopian Transfer

HCPCS-S8452-PREFABRICATED-ELBOW-SPLINT

HCPCS S8452: Prefabricated Elbow Splint

HCPCS-S9485-CRISIS-INTERVENTION-MENTAL-HEALTH-PER-DIEM

HCPCS S9485: Crisis Intervention Mental Health Services, Per Diem

HCPCS-S0320-NURSE-TELEPHONE-DISEASE-MANAGEMENT-MONITORING-MONTHLY

HCPCS S0320: Nurse Telephone Calls for Disease Management, Monthly

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Taxonomy Code	Specialty	Notes
2084P0800X	Pediatric Surgery	Pediatric/foetal thoracic surgeons who may participate in repair or postnatal management.
207V00000X	Maternal-Fetal Medicine	Maternal-fetal medicine specialists who coordinate and perform fetal interventions.
207K00000X	Obstetrics & Gynecology	Obstetric surgeons involved in maternal operative care and perioperative management.
2080S0105X	Thoracic Surgery	Cardiothoracic surgeons with fetal thoracic expertise for complex resections and vascular control.
208D00000X	Anesthesiology	Anesthesiologists experienced in maternal and fetal anesthesia for intrauterine procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q33.4`	Congenital pulmonary sequestration	Primary diagnostic code for pulmonary sequestration, indicating an aberrant lung tissue mass often requiring evaluation or intervention.
`P19.9`	Respiratory distress of newborn, unspecified	Relevant for delivery planning when fetal EPS may cause neonatal respiratory compromise (used postnatally).
`P83.8`	Other specified problems of respiratory system of newborn	Used for specific neonatal respiratory sequelae related to congenital lung malformations.
`O31.812`	Maternal care for other specified fetal problems, fetus affected by other conditions	Used for maternal encounters for fetal anomalies requiring specialized fetal therapy (coders should select the most specific code available).
`P29.0`	Neonatal pulmonary hemorrhage	Relevant if fetal lesion or intervention predisposes to hemorrhagic complications in the newborn period.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`59620`	Fetoscopy for evaluation of fetus requiring intrauterine treatment including amniotic membrane procedures (example)	May be used when fetoscopic access and evaluation are performed as part of the in utero repair workflow.
`59120`	Emergency hysterotomy, not for fetoscopic procedure (used in select emergent open fetal procedures)	Relevant when an open maternal hysterotomy is performed to access the fetus for repair.
`76937`	Ultrasound guidance for needle placement (e.g., fetal procedures)	Used intraoperatively for ultrasound guidance of needle, trocar, or fetoscopic instrument placement.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older — percutaneous	May be used for maternal central venous access required for prolonged anesthesia or intraoperative monitoring.
`99499`	Unlisted evaluation and management service (used for specialized perioperative coordination)	May be used for billing perioperative or multidisciplinary coordination services not described by standard CPT codes.

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