Uterus Transplantation for Absolute Uterine Factor Infertility
Customize your policy alerts
Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts
Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.
Monitor payer policy activity
This policy governs coverage determinations for uterus transplantation as a treatment for absolute uterine factor infertility (AUFI) for BCBSRI members, specifying medical necessity and coding stances for Medicare Advantage and Commercial products.
No material clinical or coverage changes in this revision.
Coverage Determinations
Not covered for Medicare Advantage
Coverage determinations
Source: Medicare Advantage Plans
Not medically necessary for Commercial Products
Source: Commercial Products
The following CPT codes related to donor hysterectomy, recipient transplantation, and backbench preparation/reconstruction are described in this policy and are designated as not covered / not medically necessary: 0664T (Donor hysterectomy; open, from cadaver donor), 0665T (Donor hysterectomy; open, from living donor), 0666T (Donor hysterectomy; laparoscopic or robotic, from living donor), 0667T (Recipient uterus allograft transplantation from cadaver or living donor), 0668T (Backbench standard preparation of uterine allograft prior to transplantation), 0669T (Backbench reconstruction; venous anastomosis, each), and 0670T (Backbench reconstruction; arterial anastomosis, each).
Uterus transplantation as a treatment for absolute uterine factor infertility (AUFI) is considered not medically necessary for Commercial products because the evidence is insufficient to demonstrate an improvement in net health outcomes. Associated procedure codes listed in the coding section (CPT 0664T–0670T) are therefore considered not medically necessary for Commercial members under this policy.
Procedure and Billing Codes
| 0664T | Donor hysterectomy (including cold preservation); open, from cadaver donor |
| 0665T | Donor hysterectomy (including cold preservation); open, from living donor |
| 0666T | Donor hysterectomy (including cold preservation); laparoscopic or robotic, from living donor |
| 0667T | Recipient uterus allograft transplantation from cadaver or living donor |
| 0668T | Backbench standard preparation of cadaver or living donor uterine allograft prior to transplantation, including dissection and removal of surrounding soft tissues and preparation of uterine vein(s) and uterine artery(ies), as necessary |
| 0669T | Backbench reconstruction of cadaver or living donor uterus allograft prior to transplantation; venous anastomosis, each |
| 0670T | Backbench reconstruction of cadaver or living donor uterus allograft prior to transplantation; arterial anastomosis, each |
Provider Requirements and Actions
Prior authorization — verify benefits despite 'Not applicable'
Prior authorization: Not applicable for this policy; however, providers should verify member benefits as coverage may vary by contract and applicable codes (0664T–0670T) are listed as not covered / not medically necessary in this policy.
- Policy states prior authorization: Not applicable.
- Specified procedure codes 0664T–0670T are listed as not covered / not medically necessary.
Medical criteria — policy stance (informational)
Document note: Medical criteria are listed as 'Not applicable' for this policy. Providers should follow coverage guidance in the policy which states uterus transplantation is not covered/not medically necessary for the products described.
- MEDICAL CRITERIA: Not applicable.
- Medicare Advantage: Uterus transplantation is not covered (insufficient evidence).
- Commercial Products: Uterus transplantation is not medically necessary (insufficient evidence).
Benefit verification and documentation — check EOC and contact call center
Verify member-specific benefits and eligibility before providing services by reviewing the member's Evidence of Coverage or Subscriber Agreement and contacting the provider call center for confirmation.
- Benefits may vary between groups/contracts; refer to the Evidence of Coverage or Subscriber Agreement.
- For member-specific benefits and eligibility, call the provider call center as directed in the policy.
Coverage denial risk for Medicare Advantage and Commercial products
Coverage denial risk: For Medicare Advantage plans and Commercial products, uterus transplantation is not covered or is considered not medically necessary due to insufficient evidence of improved net health outcomes; performing or billing for these services risks denial.
- Medicare Advantage: Not covered — evidence insufficient to demonstrate improved net health outcome.
- Commercial Products: Not medically necessary — evidence insufficient to demonstrate improved net health outcome.
- Related CPT codes 0664T–0670T are designated not covered / not medically necessary.
Clinical Background
Absolute uterine factor infertility (AUFI) refers to infertility due to an absent or nonfunctional uterus from congenital (eg, Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome), surgical (eg, hysterectomy), anatomical, or acquired causes that prevent embryo implantation and term pregnancy. AUFI is estimated to affect 1 in 500 females of childbearing age. Uterine agenesis/MRKH is a congenital cause; MRKH accounts for less than 3% of müllerian malformations with an estimated prevalence of 1 in 4,500 females. Hysterectomy is the most common cause of acquired AUFI, with approximately 240,000 procedures in females under age 44 in the United States. Uterus transplantation is a complex, multi-stage, typically temporary intervention that has been performed internationally and in the U.S. (35 procedures in the U.S. as of March 2022), but current evidence is insufficient to establish improved net health outcomes.
Key Definitions
Described Candidate Populations
Described candidate populations (informational)
Clinical contexts discussed (document does not define approval criteria):
Informational only; policy lists no approval criteria. Additional clinical pathway elements described include pre-transplant IVF, initiation of immunosuppression at transplantation, monitoring with cervical biopsies, embryo transfer after 6–12 months, pregnancy management, and graft removal after childbearing.
Contraindications and Increased Risk
Recipients with MRKH syndrome type II who have a single kidney face increased risk from uterus transplantation because immunosuppressive medications can cause nephrotoxicity, and pregnancy in this setting may be associated with higher rates of obstetric complications (for example, severe preeclampsia). This elevated risk profile is cited as a concern in candidate selection and program evaluation.
Pre-Transplant Evaluation
Evaluation requirements — screening, consent, IVF, and rejection monitoring
Complete pre-transplant screening and informed consent for donor, recipient, and genetic partner; perform in‑vitro fertilization prior to transplantation and follow protocolized cervical biopsies to monitor for rejection.
- Screening and consent are required for all involved parties (donor, recipient, genetic partner).
- In‑vitro fertilization is performed prior to transplantation to ensure embryo availability.
- Protocol and for‑cause cervical biopsies are used to monitor for organ rejection.
Center and Team Requirements
Center requirements — complex multi-stage procedure and multidisciplinary teams
Recognize that uterus transplantation is a complex, multi-stage procedure involving donor and recipient surgical teams, perioperative immunosuppression, embryo transfer, pregnancy management, and eventual graft removal; the policy does not specify center accreditation, volume, or FACT requirements.
- Procedure involves donor procurement (living or deceased), recipient surgery, and multidisciplinary teams.
- Immunosuppression is initiated at transplantation and continued until graft removal after childbearing.
- Policy does not state specific center accreditation or volume standards.
Post-Transplant Care and Coverage Notes
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.