In women’s health, the problem sometimes starts before the diagnosis – on the claim form.
CPT codes are how physicians indicate the services they provide so insurers can determine coverage. As in so many areas of women’s health, women lose out because this system does not fully recognize or support the care they need.
Today, there are more than 50 women’s health conditions with no dedicated CPT code. In some cases, coverage and codes exist for men but not for women; in others, no codes exist at all for female-specific conditions.
The implications are obvious. Clinicians have no clear way to bill for these conditions, so there is less motivation to diagnose and treat. Patients pay more out of pocket. And innovators face extra hurdles, because they often need new CPT codes before they can establish reimbursement pathways, which slows innovation.
In the United States, reimbursement values are set through a complex system driven by the Centers for Medicare and Medicaid Services (CMS) and an American Medical Association (AMA) committee. That process is deeply flawed. If you want to understand it better, I highly recommend Jodi Neuhauser‘s In Women’s Health webinar available on YouTube –
There are several organizations working hard to surface these inequities and address them. Until women’s conditions are fully reflected in CPT codes, care and innovation will lag. Join organizations like Women’s Health Advocates (WHA) and 51& to help change that.
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