Fetal Surgery

TRICARE covers the following fetal surgeries when provided by a perinatal or pediatric specialist:

• Prenatal surgical intervention consisting of vesicoanmiotic shunting in fetuses with hydronephrosis due to bilateral urinary tract obstruction together with evidence of:
  • Progressive oligohydramnios.
  • Adequate renal function as generally defined by normal urinary electrolytes.
  • No other lethal abnormalities or chromosomal defects.
• Prenatal surgical intervention of temporary tracheal occlusion of congenital diaphragmatic hernia (CDH) for fetuses with:
  • A prenatal diagnosis of CDH, gestational age of less than 25 weeks at time of diagnosis.
  • Evidence of liver herniation.
  • Other indicators of poor prognosis, such as a low lung-to-head ratio.
• Prenatal intervention of either:
  • An open in-utero resection of malformed pulmonary tissue, or
  • Placement of a thoraco-amniotic shunt. Applies in cases of hydrothorax or large cystic lesions for fetuses congenital cystic adenomatoid malformation or extralobar pulmonary sequestration, who are of less than 32 weeks' gestation and who have evidence of progressive hydrops, placentomegaly and/or the beginnings of maternal mirror syndrome.
• Twin-twin transfusion syndrome, gestation age of less than 25 weeks' gestation at the time of diagnosis.
• Sacrococcygeal teratoma in the presence of fetal hydrops and/or placentomegaly in fetuses with less than 28 weeks of gestation.
• Open fetal surgery for surgical repair of myelomeningocele (MMC) if:
  • The fetus’ gestation age is 19.0 to 25.9 weeks.
  • MMC is present with an upper boundary located between T1 through S1 with evidence of hindbrain herniation.
• Other conditions when determined to be medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition..

 If you have questions or need more information about these services, call:

• Health Net Federal Services at 1-844-524-3578. Choose option 4 for maternity fetal support.
• Humana Military at 1-800-881-9227 for the Integrated Care Team.