Does S2405 require prior authorization?

No, S2405 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for S2405?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S2405`, Repair of sacrococcygeal teratoma in the fetus, procedure performed in utero

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Imaging/diagnostic documentation (prenatal ultrasound) confirming LUTO, CPAM/BPS, pleural effusion/hydrops, or TTTS.
For TTTS: documentation of Quintero stage, gestational age, and relevant maternal signs and symptoms.

Key Coverage Criteria

Maternal contraindications to fetoscopic surgery or severe medical conditions that would make fetal intervention riskful;and
Fetal surgery is consideredmedically necessarywhen ANY of the following criteria sets (I-V) are met:
Vesico-amniotic shunting as a treatment of urinary tract obstruction in fetuses whenallthe following conditions are met:Bilateral obstruction;andEvidence of progressive oligohydramnios;andAdequate renal function reserves;andNo other lethal or chromosomal abnormalities.
Bilateral obstruction;and
Evidence of progressive oligohydramnios;and
Adequate renal function reserves;and

7 Active Policies

ANTHEM-CG-SURG-121, Fetal Surgery for Prenatally Diagnosed Malformations

ANTHEM-RAD.00012, THER-RAD.00012 Electrophysiology-Guided Noninvasive Stereotactic Cardiac Radioablation

AMBETTER-CP.MP.129, Fetal Surgery in Utero for Prenatally Diagnosed Malformations

BCBSIL-SUR701.016, Fetal Surgery for Prenatally Diagnosed Malformations

BCBSMT-SUR701.016, Fetal Surgery for Prenatally Diagnosed Malformations

BCBSNM-SUR701.016, Fetal Surgery for Prenatally Diagnosed Malformations

BCBSOK-SUR701.016, Fetal Surgery for Prenatally Diagnosed Malformations

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S2405, Repair of sacrococcygeal teratoma in the fetus, procedure performed in utero