Cigna Abortion - (A006) Form

Comparative Genomic Hybridization (CGH)/Chromosomal Microarray Analysis (CMA) for Selected Hereditary Conditions

Genetic Testing for Reproductive Carrier Screening and Prenatal Diagnosis

PURPOSE

Administrative Policies are intended to provide further information about the administration of standard Cigna benefit plans. In the event of a conflict, a customer’s benefit plan document always supersedes the information in an . Coverage determinations require consideration of 1) the terms of the applicable benefit plan document; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Administrative Policies and; 4) the specific facts of the particular situation. Administrative Policies relate exclusively to the administration of health benefit plans. Administrative Policies are not recommendations for treatment and should never be used as treatment guidelines.

Coverage for abortion is subject to the terms, conditions and limitations of the applicable benefit plan and may be subject to state regulations. Standard Cigna benefit plans consider both elective and therapeutic abortion to be covered benefits. Cigna covers medically necessary treatment of complications following an abortion.

General Background

Abortion is the induced or spontaneous termination of pregnancy. Abortion may be considered elective or therapeutic. An abortion may be performed by medical (e.g., administration of medication) or surgical (e.g., dilation and curettage [D&C]) intervention. Medications commonly used for abortion include mifepristone, also known as RU486 (Mifeprex, Danco Laboratories, LLC, New York, NY) and misoprostol, used in combination with mifepristone.

Elective Abortion

For the purpose of this an elective abortion is the termination of pregnancy at the discretion of the woman for reasons other than maternal health or fetal disease. Elective abortion is reflected when ICD-10-CM code Z33.2 (Encounter for elective termination of pregnancy) is either billed alone or with Z32.01 (Encounter for pregnancy test, result positive).

Therapeutic Abortion

: A006 For the purpose of this a therapeutic abortion is the termination of a pregnancy due to underlying conditions related to maternal health or fetal disease. These conditions may be represented by a broad array of ICD-10 diagnosis codes. Indications for a therapeutic abortion include, but are not limited to the following conditions that may affect the woman or the fetus:

• diabetes mellitus
• ectopic pregnancy
• exposure to a teratogenic substance known to cause developmental malformation(s) of the fetus
• mental health and addiction disorders
• metabolic disorders (e.g., Tay-Sachs disease)
• pregnancy due to rape or incest
• fetal genetic abnormalities
• fetal death prior to the age of viability
• fetal structural defects (e.g., neural tube defects, cardiac abnormalities)
• infectious disease with potential for significant complications (e.g., Zika virus, typhoid, measles)
• renal disease
• cancer
• cardiovascular, hematologic or pulmonary disease
• congenital heart disease

A spontaneous abortion is used to describe the early loss of pregnancy (e.g., miscarriage) not caused by medical or surgical intervention. Spontaneous abortion includes missed or incomplete abortion (i.e., all or part of the products of conception are retained in the woman’s body) and infected/septic abortion. The presence of a spontaneous abortion and resulting complications may require medical or surgical treatment.

Ectopic pregnancy occurs when a fertilized egg implants in the fallopian tube or in the abdomen rather than the uterus, resulting in a nonviable pregnancy.

Ectopic pregnancy constitutes a life-threatening condition and may require immediate surgical intervention.