CMS Pub. 100-02, ch. 15, § 20.1

B3-2005.l

A. Surgery and Childbirth

Skilled medical management is covered throughout the events of pregnancy, beginning with diagnosis,

continuing through delivery and ending after the necessary postnatal care. Similarly, in the event of

termination of pregnancy, regardless of whether terminated spontaneously or for therapeutic reasons (i.e.,

where the life of the mother would be endangered if the fetus were brought to term), the need for skilled

medical management and/or medical services is equally important as in those cases carried to full term.

After the infant is delivered and is a separate individual, items and services furnished to the infant are not

covered on the basis of the mother’s eligibility.

Most surgeons and obstetricians bill patients an all-inclusive package charge intended to cover all services

associated with the surgical procedure or delivery of the child. All expenses for surgical and obstetrical

care, including preoperative/prenatal examinations and tests and post-operative/postnatal services, are

considered incurred on the date of surgery or delivery, as appropriate. This policy applies whether the

physician bills on a package charge basis, or itemizes the bill separately for these items.

Occasionally, a physician’s bill may include charges for additional services not directly related to the

surgical procedure or the delivery. Such charges are considered incurred on the date the additional services

are furnished.

The above policy applies only where the charges are imposed by one physician or by a clinic on behalf of a

group of physicians. Where more than one physician imposes charges for surgical or obstetrical services, all

preoperative/prenatal and post-operative/postnatal services performed by the physician who performed the

surgery or delivery are considered incurred on the date of the surgery or delivery. Expenses for services

rendered by other physicians are considered incurred on the date they were performed.

B. Treatment for Infertility

Reasonable and necessary services associated with treatment for infertility are covered under Medicare.

Infertility is a condition sufficiently at variance with the usual state of health to make it appropriate for a

person who normally is expected to be fertile to seek medical consultation and treatment.