(244) MEDICAID COVERAGE OF INFERTILITY TREATMENTS

Abstract Introduction Infertility is experienced by 15% of couples, with up to 50% of cases related to male factors. Unfortunately, infertility treatments are expensive and infrequently covered by insurance, burdening patients and deterring access to care. However, Medicaid patients are even less likely to pursue treatments. Of 92 million Medicaid enrollees, 31 million are between the ages of 18 to 44, prime age for fertility intervention. However, transparency of Medicaid coverage of fertility interventions is low. Objective In this study, we evaluated Medicaid coverage status and physician reimbursement for the most common infertility-related interventions. Methods Physician fee schedules were accessed through state Medicaid websites for the year 2023. The fee schedules were searched for current procedural terminology (CPT) codes used for male infertility interventions. The Medicaid physician fee index was accessed for each state and linear regression analysis was performed to assess if state reimbursements were attributable to a tendency for that state to reimburse more for Medicaid services. Results Of the 50 US states analyzed, 49 publish accessible physician fee schedules. Tennessee requires patient claim data to be submitted before releasing fee schedules. No states offered reimbursement for microscopic testicular extraction of sperm thus requiring alternatives for coding, or the use of out-of-pocket billing. Certain procedures were covered by every state, such as testis biopsy, while others were rarely covered, such as vasovasostomy (table 1). Reimbursement patterns for several CPTs significantly varied based on the state physician fee index, although these were typically weak correlations (table 2). Conclusions Discrepancies in state coverage and reimbursement for fertility procedures is evident. Some of the discrepancies can be explained by state fee indexes, however the absence of clear methodology behind a state’s decision to cover fertility procedures and physician reimbursement rates both contribute to overall lack of transparency within Medicaid. This lack of transparency may be partially responsible for underutilization of infertility treatments in Medicaid patients. Disclosure No.