Reimbursement Policy Update: Abortion (Termination of Pregnancy)

Beginning with dates of service on or after August 1, 2025, we will update the Abortion (Termination of Pregnancy) reimbursement policy to include reimbursement for induced abortions. These will be reimbursable when they meet specific criteria:

• Induced abortions are allowed only when written voluntary and informed consent has been obtained from the woman upon whom the abortion is to be performed and where a physician has found and certified in writing that, based on their professional judgment, the abortion is necessary to save the life of the mother.
• Reimbursement is based on the applicable fee schedule or contracted/negotiated rate when the state-approved Certification of Medical Necessity abortion form and documentation are properly executed and submitted with the provider’s claim.

Please note that informed consent is not necessary for treating incomplete, missed, or septic abortions. These are not considered induced or elective abortions and are allowed under the medical necessity criteria.

For additional information, please review the Abortion (Termination of Pregnancy) reimbursement policy at https://providers.anthem.com/va.