{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T20:35:50Z","timestamp":1768077350926,"version":"3.49.0"},"reference-count":13,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"published-print":{"date-parts":[[2022,3]]},"abstract":"Madison Kilbride recently argued that insurance (eg, Centers for Medicare & Medicaid Services (CMS)) should cover in vitro fertilisation with preimplantation genetic testing (IVF-PGT) services for couples at high risk of having a child affected with a genetic condition. She argues that IVF-PGT meets CMS\u2019s definition of \u2018medically necessary care\u2019, where such care includes \u2018services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms\u2019. Kilbride argues that IVF-PGT satisfies this definition in two ways: as a diagnostic tool and as a treatment. Contradicting Kilbride, however, I argue that IVF-PGT provides neither<\/jats:italic> diagnosis nor treatment under CMS\u2019s definition. Thus, as long as we accept CMS\u2019s definition of medically necessary care\u2014which Kilbride does, explicitly\u2014it follows that IVF-PGT does not count as medically necessary care. Still, there may be other reasons to conclude that IVF-Preimplantation genetic testing should be covered, and so, it would be a mistake to reject Kilbride\u2019s conclusion altogether. The problem is simply that Kilbride\u2019s argument<\/jats:italic>\u2014that the procedure should be covered because it is medically necessary per CMS\u2019s definition\u2014is not sound. I conclude by discussing a number of other genetic services that are not currently being covered despite the fact that (unlike IVF-PGT) they do<\/jats:italic> seem to satisfy CMS\u2019s definition of \u2018medically necessary diagnosis or treatment\u2019. These services, I argue, should be provided under CMS before we consider expanding coverage to include elective procedures such as IVF-PGT.<\/jats:p>","DOI":"10.1136\/medethics-2020-106940","type":"journal-article","created":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T18:25:18Z","timestamp":1613759118000},"page":"202-204","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Expanding insurance coverage for in vitro fertilisation with preimplantation genetic testing: putting the cart before the horse"],"prefix":"10.1136","volume":"48","author":[{"given":"Emily C","family":"Lisi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"key":"2022030104400698000_48.3.202.1","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2019-105879"},{"key":"2022030104400698000_48.3.202.2","unstructured":"HealthCare.gov . Medically Necessary - HealthCare.gov Glossary, 2020. Available: https:\/\/www.healthcare.gov\/glossary\/medically-necessary\/ [Accessed 8 Sep 2020]."},{"issue":"3","key":"2022030104400698000_48.3.202.3","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1097\/AOG.0000000000003714","article-title":"Preimplantation genetic testing: ACOG Committee opinion, number 799","volume":"135","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"1","key":"2022030104400698000_48.3.202.4","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1093\/humrep\/dey327","article-title":"Assessment of aneuploidy concordance between clinical trophectoderm biopsy and blastocyst","volume":"34","author":"Victor","year":"2019","journal-title":"Hum Reprod"},{"key":"2022030104400698000_48.3.202.5","unstructured":"42 CFR \u00a7 440.210 - Required services for the categorically needy, 2020. Available: https:\/\/www.law.cornell.edu\/cfr\/text\/42\/440.210 [Accessed 8 Sep 2020]."},{"key":"2022030104400698000_48.3.202.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-5914.1976.tb00359.x"},{"key":"2022030104400698000_48.3.202.7","unstructured":"Discover infertility treatment coverage by U.S. state. resolve, 2020. Available: https:\/\/resolve.org\/what-are-my-options\/insurance-coverage\/infertility-coverage-state\/ [Accessed 8 Sep 2020]."},{"key":"2022030104400698000_48.3.202.8","unstructured":"Sutphen R . How Medicare coverage of genetic counseling could decrease care costs and improve quality, 2018. Available: https:\/\/www.medicaleconomics.com\/view\/how-medicare-coverage-genetic-counseling-could-decrease-care-costs-and-improve-quality [Accessed 8 Sep 2020]."},{"key":"2022030104400698000_48.3.202.9","unstructured":"ABGC . ABGC - State Licensure Information for Genetic Counseling. Available: https:\/\/www.abgc.net\/research-resources\/state-licensure\/ [Accessed 16 Sep 2020]."},{"key":"2022030104400698000_48.3.202.10","unstructured":"Loebsack D . Text - H.R.3235 - 116th Congress (2019-2020): Access to Genetic Counselor Services Act of 2019, 2019. Available: https:\/\/www.congress.gov\/bill\/116th-congress\/house-bill\/3235\/text [Accessed 8 Sep 2020]."},{"key":"2022030104400698000_48.3.202.11","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.genom.9.081307.164319"},{"key":"2022030104400698000_48.3.202.12","unstructured":"Campbell M . Limitations of health reports from direct-to-consumer genetic tests are identified, 2019. Available: https:\/\/www.technologynetworks.com\/genomics\/news\/limitations-of-health-reports-from-direct-to-consumer-genetic-tests-are-identified-325877 [Accessed 8 Sep 2020]."},{"issue":"1","key":"2022030104400698000_48.3.202.13","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/j.1467-8519.2008.00681.x","article-title":"Reproductive autonomy, the non-identity problem, and the non-person problem","volume":"23","author":"DiSilvestro","year":"2009","journal-title":"Bioethics"}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/medethics-2020-106940","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T12:42:03Z","timestamp":1646138523000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/medethics-2020-106940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,19]]},"references-count":13,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,1]]},"published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1136\/medethics-2020-106940"],"URL":"https:\/\/doi.org\/10.1136\/medethics-2020-106940","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"value":"0306-6800","type":"print"},{"value":"1473-4257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,19]]}}}