Reimbursement in Women's Health

Everything you need to know — and why it changes everything.

Nothing changes in women's health until reimbursement changes.

More research funding is great — but without a commercialization pathway, the trillion-dollar opportunity in women's health stays out of reach. Reimbursement is the invisible lever that controls everything: whether a clinician can afford to offer a service, whether a startup can build a viable revenue model, whether an investor can exit.

Women's health has an R&D problem — and not Research & Development. The real R&D is Research & Reimbursement, Data & Demand.

The formula behind every doctor's paycheck — and why it's broken for women.

Every medical service maps to a CPT code. Each CPT code carries a number of RVUs (Relative Value Units). Multiply those RVUs by the government-set conversion factor, and you get what a physician is paid. Sounds simple — until you look at who sets the RVU values.

That's the job of the RUC Committee — a 31-member panel coordinated by the AMA whose recommendations are accepted by CMS 80–90% of the time. The RUC Committee has one OB-GYN and no gynecological surgeon. Only 12% of voting members are women.

To make it tangible: a complete IUD insertion visit — the procedure itself, an office visit, and a transvaginal ultrasound — reimbursed $189.07 in 2020. In 2026, the same visit pays $175.01. That's $14 less in nominal dollars. Adjust for inflation and the real loss is far greater.

Meanwhile, doctors' operating costs keep rising — staff, rent, insurance — while their reimbursement goes down. This is why your OB-GYN can only spend seven minutes with you. Not because they don't want to. Because they have to see 30–50 patients a day just to keep the lights on.

We are not worth 30% less — but our billing system says we are.

Researchers compared 55 gender-specific procedures — the same procedure, done on a man or a woman. The findings are stunning:

This traces directly back to the composition of the RUC committee, the allocation of RVUs, and the budget neutrality rule — which caps the total RVUs available and forces specialties to fight each other for their piece of the pie. Women's health rarely wins that fight.

The math on why labor & delivery units are closing.

In Alabama, Medicaid — which covers 80% of births in that state — reimburses $1,800 for a delivery. It costs a hospital $5,600 to staff and deliver a baby. A 2023 federal Medicaid program compounded the crisis by paying hospitals $3M to keep admissions under 24 hours, forcing closure of all units except the ER. Travel time to the nearest hospital in some communities went from 25 minutes to 90 minutes. In obstetrics, things can turn fatal in under 15 minutes.

The One Big Beautiful Bill (signed July 4, 2025) makes this worse: $900B+ in Medicaid cuts over 10 years. The CBO estimates 10 million more uninsured by 2034, including 7.5 million losing Medicaid. An estimated 2.1 million women aged 19–49 are at risk from work requirements alone — and 140+ labor & delivery units are projected to close as a result. Medicaid covers 40% of all U.S. births. The same bill that cut $900B gave providers a one-year conversion factor bump.

Between 2010 and 2022, over 500 hospitals already closed their obstetric units, with rural hospitals accounting for more than 200 of those closures. The number of rural L&D hospitals that closed in just the first half of 2025 nearly matched all of 2024.

Read the full coverage: The Free Press — Alabama Case Study  |  TIME: Why Maternity Care Is Underpaid

Ready to go deeper? The Women's Health Mini-MBA is enrolling now.

Tonight we covered the surface. The Mini-MBA goes six layers deeper — reimbursement is one week of a six-week deep dive into the entire business of women's health.

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There is progress. Here's where to look.

In February 2026, BCG and the Milken Institute identified four structural barriers blocking women's health coverage: FDA approval doesn't equal payer coverage; low RVUs make women's health financially unattractive; 50+ conditions have no CPT code; and the data cycle is self-reinforcing — no code means no data, means no guidelines, means no new codes.

In March 2025, 67 C-suite executives built the first women's health reimbursement policy roadmap — spanning the RUC Committee, maternal health, fertility, and preventive care. Their fertility recommendations were incorporated into the White House report following the executive order on fertility.

Coming January 1, 2027: the biggest structural change to OB billing in decades — global obstetric codes deleted, replaced by itemized visit-level billing. New pathways for preconception and prenatal care open up. Practices should be preparing now. And in Arkansas, the Healthy Moms, Healthy Babies Act just committed $45.3M annually to maternal care — proof that strategic investment can move the needle.