Summary & Overview
HCPCS S2404: Repair of Fetal Myelomeningocele, In Utero
HCPCS Level II code S2404 denotes in utero surgical repair of a fetal myelomeningocele, a form of open fetal surgery aimed at closing a spinal neural tube defect before birth. This intervention is clinically significant because prenatal repair can change neurological outcomes, influence delivery planning, and affect neonatal and maternal perioperative management. The procedure is high-acuity, resource-intensive, and typically performed in specialized tertiary centers.
Key payers included in the national context are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage considerations and benchmarks across major payers, though specific payer policy language and rates vary by plan.
Readers will find a concise briefing on clinical context and coding scope for S2404, typical sites of service, common modifiers and billing considerations (listed elsewhere in this publication), and the kinds of documentation and multidisciplinary care associated with fetal surgery. The report highlights areas where policy updates and payer coverage determinations commonly arise—such as medical necessity criteria, prior authorization requirements, and distinctions between in utero and postnatal surgical approaches. Data not provided in the input are noted where applicable. This summary equips coding, billing, and clinical teams with a clear national-level understanding of what HCPCS Level II code S2404 represents and where to focus further policy or reimbursement inquiries.
Billing Code Overview
HCPCS Level II code S2404 represents repair of myelomeningocele in the fetus, procedure performed in utero. This code describes a fetal surgical procedure intended to repair a neural tube defect (myelomeningocele) prior to birth.
-
Service type: Fetal surgical intervention (in utero fetal surgery)
-
Typical site of service: Hospital-based operating room or specialized fetal surgery center, with maternal-fetal medicine and pediatric surgical teams
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A pregnant patient (typically 19–26 weeks gestation) with a fetal diagnosis of open myelomeningocele is evaluated at a maternal-fetal medicine center for consideration of in utero fetal surgery. The workflow begins with referral after targeted ultrasound or fetal MRI identifies a defect in the fetal spinal canal consistent with myelomeningocele. A multidisciplinary team (maternal-fetal medicine physician, pediatric neurosurgeon, anesthesiologist, neonatologist) confirms candidacy, reviews maternal and fetal risks, and obtains informed consent.
Preoperative preparation includes detailed fetal imaging, maternal laboratory testing, and anesthesia planning. On the day of surgery, the mother undergoes general anesthesia with uterine relaxation; the maternal-fetal medicine surgeon and pediatric neurosurgeon perform a hysterotomy and repair the fetal spinal defect in utero (closure of the myelomeningocele sac and reconstruction of meninges and skin). Intraoperative fetal monitoring and tocolysis are used. Postoperative care includes maternal monitoring for preterm labor, administration of magnesium sulfate per protocol, serial ultrasounds to assess fetal well-being, and planned delivery at a tertiary center with pediatric neurosurgery and NICU capability. Documentation emphasizes fetal diagnosis, intrauterine operative details, personnel involved, anesthesia, and postoperative maternal/fetal status for accurate billing of S2404 (Repair, myelomeningocele in the fetus, procedure performed in utero).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|