Fetal Surgery in Utero for Prenatally Diagnosed Malformations

This policy covers in‑utero fetal surgery (open and fetoscopic/minimally invasive) to treat prenatally diagnosed malformations, including sacrococcygeal teratoma resections, vesico‑amniotic shunting for LUTO, thoraco‑amniotic shunting or resection for CPAM/BPS and pleural effusion, fetoscopic laser ablation or amnioreduction for TTTS, ablation for TRAP sequence, fetal myelomeningocele repair, and FETO for severe left congenital diaphragmatic hernia. Coverage requires specific clinical criteria and timing (e.g., myelomeningocele repair in singletons at 19 0/7–25 6/7 weeks, fetoscopic laser for TTTS at 16–26 weeks, FETO ≤30 weeks with O/E LHR <25%), absence of listed contraindications (e.g., Altman III/IV SCT, severe placentomegaly, cervical shortening, multiple fetal anomalies or chromosomal abnormalities for shunting), appropriate maternal assessment/Quintero staging, and available technical expertise; several procedures (in utero gene/stem‑cell therapy, tracheal atresia/stenosis repair, certain cardiac interventions, cleft lip/palate repair) are not supported.