Does S2409 require prior authorization?

No, S2409 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S2409?

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

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

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.

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

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

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

Ask Backwork about documentation requirements, denial risks, or coverage in your state.