Publicly Available Information on Insurance Coverage for Maternal-Fetal Surgery

Importance Maternal-fetal surgery has expanded rapidly in the US, but how insurance coverage supports delivery of this specialized, high-cost care has not been systematically characterized. Objective To characterize publicly ascertainable information about how Medicaid programs and large commercial insurers cover procedures used in maternal-fetal surgery. Design, Setting, and Participants This cross-sectional descriptive study analyzed insurance coverage policies in the US from March through August 2025. Medicaid programs and large commercial insurers were selected based on national market share. Exposure Insurance coverage policies for maternal-fetal surgery–related procedures were assessed using publicly available fee schedules and structured outreach to payer representatives. Main Outcomes and Measures Coverage status (covered, not covered, or data not available) for 19 maternal-fetal surgery–related Current Procedural Terminology ( CPT ) and Healthcare Common Procedure Coding System (HCPCS) codes and 5 comparator codes. Results The study included 50 state Medicaid programs and 30 large commercial insurers. Among Medicaid programs, coverage was high for nonspecific or individual components of procedures (eg, intrauterine transfusion: 49 of 49 available determinations [100%]) but incomplete and highly variable for codes specific to comprehensive interventions (eg, 6 of 36 available determinations [16.7%] for in utero sacrococcygeal teratoma resection). Among 44 states with available determinations for both code types, mean (SD) coverage was higher for CPT codes than S-codes (86.3% [14.1%] vs 53.0% [37.0%]; P < .001), with consistent findings in sensitivity analyses. The median (range) proportion of MFS-related codes covered per state was 14.5 (0-19) of 19 codes (76.3%). Among 5 commercial insurers with data, all 5 (100.0%) reported coverage of all 4 S-codes representing comprehensive interventions. Conclusions and Relevance In this study, coverage of maternal-fetal surgery–related codes was incomplete and variable, and transparency in commercial coverage policies was limited. These findings suggest that coverage uncertainty may complicate health-system planning and financing for this increasingly used, high-cost care.