Fetal Surgery - (0175)

Cigna covers only specific in‑utero fetal surgeries—prenatal myelomeningocele repair, fetoscopic laser coagulation for severe TTTS, fetal lobectomy for CPAM/CCAM with hydrops, and fetoscopic endoluminal tracheal occlusion (FETO) for severe left CDH (CPT 59897 when criteria met)—and considers all other fetal interventions (e.g., in‑utero gene therapy, sacrococcygeal teratoma ablation, amniotic band release, fetal shunting for hydrocephalus, most prenatal CHD surgeries) not medically necessary. Coverage requires strict, indication‑specific criteria (specified gestational age windows, singleton pregnancies where required, lesion/imaging and genetic findings such as normal karyotype or O/E LHR <25%, evidence of hydrops or abnormal Dopplers for TTTS), performance at specialized multidisciplinary centers with Level III NICU/ECMO availability, and complete supporting documentation and informed consent.

"myelomeningocele repair when ALL of the following criteria are met: singleton pregnancy; myelomeningocele with the upper boundary of the lesion located between T1 and S1; evidence of hindbrain hern..."