Background:
The Policy and Finance Working Group of the Preconception Care Initiative raised the question: “What specific changes in health coverage and financing are needed to support change in clinical practice?” Perhaps the greatest challenge will be to identify resources for millions of women of childbearing age who do not have health insurance. Concurrently, it is important to understand whether commercial and public payers are covering “preconception care” services.

Objectives:
The purpose of this analysis was to describe the billing and reimbursement patterns for preconception services at one academic institution.

Methods:
Our institution's the billing and reimbursement database was queried for all preconception services provided by the Maternal Fetal Medicine specialists from July 05 through April 07. Services coded as V26.4 (General counseling and advice for procreative management) and V26.8 (Other specified procreative management) were extracted.

Results:
This query identified 118 services. 19% of patients were self referred new patients; 54% were consultations referred by another provider; 26% were established patients (including Interconception care). 89% had commercial insurance; only 2% were self pay. The median charge for service was $210. Services were reimbursed, at least in part, for 100/103 insured patients; median third party payment $118 with median co-pay of $22. 118 services represent only a small fraction of the preconception counseling visits provided at our institution during this time period. A majority of services were billed using different codes and are thus can not be tracked through this mechanism.

Conclusion and implications for practice:
Preconception care services coded with V codes are reimbursed by the majority of commercial insurance carriers. Codes are available for describing the service, but are not uniformly utilized. These preventive service codes can be included in advocacy efforts to expand coverage for preconception care.