Fetal Surgery for Prenatally Diagnosed Malformations

This policy covers fetoscopic and open fetal surgical interventions for select prenatally diagnosed malformations — for example, vesico-amniotic shunting for bilateral urinary tract obstruction, fetoscopic or open procedures for CCAM/BPS and sacrococcygeal teratoma, in‑utero vessel occlusion or laser for TRAP/TTTS, in‑utero myelomeningocele repair, and FETO/fetoscopic repair for severe left‑sided CDH. Coverage is restricted to narrowly defined clinical scenarios with specific gestational‑age limits (e.g., myelomeningocele <26 weeks, CDH <29+6 weeks, open pulmonary/sacrococcygeal procedures ≤32 weeks, TTTS laser <26 weeks), requires absence of lethal or chromosomal anomalies and adequate fetal function, usually mandates singleton pregnancy, and excludes cases with maternal or technical contraindications (e.g., BMI ≥35 kg/m², short cervix ≤15 mm, prior upper‑segment hysterotomy, placenta previa).

"Vesico-amniotic shunting for bilateral fetal urinary tract obstruction when there is hydronephrosis due to bilateral obstruction, progressive oligohydramnios, adequate fetal renal function, and no ..."