Most HMSA plans cover induced abortions (CPT codes 59840 and 59841). When these procedures are performed in the physician’s office, HMSA plans also provide additional payment to reimburse the physician for any overhead costs.
To verify whether an induced abortion is a benefit of your patient’s plan, please call a Provider Services representative and inform them of your patient’s HMSA membership ID number and coverage code number.
Federal Plans – Limitations
The following federally funded health plans cover induced abortion only under limited circumstances.
- Federal Employee Program (FEP) Federal Employees Health Benefits (FEHB) Program – coverage codes 104, 105, 106, 111, 112, 113, 131, 132, and 133.
- Federal Employee Program (FEP) Postal Service Health Benefits (PSHB) Program – coverage codes 33D, 33E, 33F, 33A, 33B, 33C, 35A, 35B, and 35C.
- Federal Employees Health Benefits (FEHB) Program – coverage code 87.
- Postal Service Health Benefits (PSHB) Program – coverage code M6.
Federally funded health plans provide coverage for induced abortions or related services (e.g., office visits or lab and X-ray services) only when the mother’s life would be endangered if the fetus were carried to term, or when the pregnancy is from rape or incest.
Precertification of Benefits
It is recommended that providers precertify benefits if a federal plan member’s life would be endangered if the fetus were carried to term. The precertification will facilitate claim processing. To precertify, please complete HMSA’s Precertification Request [PDF] and mail or fax the form and pertinent documentation as indicated on the form.
Claims Filing Information
If you precertified an induced abortion for a federal plan member, please enter the precertification number in Block 23 of the CMS 1500 claim form.
It is not necessary to precertify benefits in cases of rape or incest. However, please submit a claim indicating the appropriate circumstantial diagnosis code (ICD-9: E960.1/ICD-10: Y04.8xxA - rape; or ICD-9: E967.0 or E967.1/ ICD-10: Y07.11, Y07.13, Y07.430, Y07.432, or Y07.499 - incest) as a secondary diagnosis.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |