Medicaid coverage of male infertility treatments

Background: Infertility treatments are costly and have poor coverage, thereby deterring or limiting access to care. Medicaid patients are even less likely than the average patient to pursue intervention and there is limited transparency of coverage of fertility interventions. We aimed to evaluate Medicaid reimbursement of common interventions used for the diagnosis and/or treatment of male infertility. Methods: Physician fee schedules were accessed for the year 2023. Current procedural terminology codes utilized for male infertility interventions were evaluated. The Medicaid physician fee index was accessed on a state by state basis. Linear regression analysis was performed to determine whether reimbursements were attributable to a state’s tendency to reimburse more for Medicaid services. Results: 49 states publish accessible physician fee schedules. No states offered reimbursement for microscopic testicular extraction of sperm thus requiring coding alternatives. Certain procedures were covered by every state (testis biopsy), while others were rarely covered (vasovasostomy). Reimbursement patterns significantly varied based on the state physician fee index, although these were weak correlations. Conclusions: Discrepancies in coverage and reimbursement for fertility procedures is evident. The absence of clear methodology regarding coverage and reimbursement contribute to poor transparency within Medicaid which may be partially responsible for the underutilization of infertility treatments among Medicaid patients.

Male; Infertility; Reimbursement

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