Generally, circumcision isn't medically necessary. Parents may decide to have their newborn males circumcised for social, cultural, or religious reasons. There are medical reasons we may recommend circumcision, such as preventing bacteria from getting trapped and lowering the risk of infections.
Z41.2What are the appropriate procedure and diagnosis codes for newborn circumcision?ICD-10-CM code: Z41.2Encounter for routine and ritual male circumcisionCPT codes: 54150Circumcision, using clamp or other device with regional dorsal penile or ring block1 more row•Dec 1, 2015
Private health plans usually cover the cost of newborn circumcision, but Medicaid plans do not provide coverage for the procedure in 18 states. In both private and public health plans, coverage of nonmedical circumcision for older boys is less common and can decrease access to this procedure.
Other specified disorders of penis N48. 89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM N48. 89 became effective on October 1, 2021.
Code 54150 is now reported for circumcision by clamp or other device with regional dorsal penile or ring block regardless of age. If a circumcision using clamp or other device is performed without regional dorsal penile or ring block, then modifier −52 for reduced services should be appended to code 54150.
CPT® Code 54161 in section: Circumcision, surgical excision other than clamp, device, or dorsal slit.
Will Medicare or private health insurance cover the cost of circumcision? You can claim a Medicare rebate only if there's a medical reason for your child's circumcision. The rebate will cover a portion of the total cost. If you have private health insurance, you may be able to claim the costs involved in circumcision.
Medicare does not generally cover circumcision of infants, children or adults, and the procedure is not listed as covered on the Medicare website. It is also highly unlikely to be included in Medicare Advantage Plans, but some private health care insurers may pay for circumcision.
We cover other care of a newborn who requires professional services or non-routine treatment, only if we cover the newborn under a Self Plus One or Self and Family enrollment. Surgical benefits apply to circumcision when billed by a professional provider for a male newborn.
ICD-10 code: N47 Redundant prepuce, phimosis and paraphimosis.
54163CPT codes 54162 and 54163 will be reported for revision of circumcision or complication developed in post-circumcision.
ICD-10 code N47. 1 for Phimosis is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .
The average hospital cost of a circumcision nationwide is about $2,000, according to the Department of Health and Human Services. However, many insurance plans treat the procedure as elective and thus won't cover it unless medically necessary.
Is there an Age Limit on Who Can be Circumcised? Men can be circumcised at any age. Children can also be circumcised at any age. Whether a man is 18 years old or 86 years old, if he desires to be circumcised or has a medical necessity to undergo circumcision, he can undergo circumcision at any time.
All Major Insurances Cover the Costs of Treatment for Phimosis in Adults and Children. Major insurance companies such as Blue Cross Blue Shield, AETNA, CIGNA, GHI/HIP, United healthcare, and Medicare as well as 1199 plans cover the costs of circumcision treatment for phimosis.
Most health insurance plans offered by AETNA cover the costs of adult circumcision when performed for medically necessary reasons. Circumcision performed for religious, aesthetic or hygienic reasons is not typically covered by AETNA.
Clinical Coverage Policy 1A-22, Medically Necessary Circumcision, has been revised and will post with an effective date of Jan. 1, 2021 on the Physician Clinical Coverage Policies page of the NC Medicaid website.
Circumcision also lowers the risk of penile cancer over a lifetime, reduces the risk of cervical cancer in sexual partners and lowers the risk of urinary tract infections in the first year of life.
A preponderance of high-quality evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure and could be considered medically necessary in certain circumstances. The health benefits of circumcision include lower risks of acquiring Human Immunodeficiency Virus (HIV), genital herpes, ...
Male circumcision is considered medically necessary when the individual is undergoing surgical repair of congenital urethral or genital abnormalities.
Male circumcision is a surgical procedure to remove the foreskin of the penis. This document addresses circumcision in males older than 4 weeks in corrected age (corrected age is defined as birth age minus the number of weeks a child is born prematurely). Note: This document does not address routine male circumcisions performed for ...
Circumcision may be performed as part of a surgical repair of congenital urethrogenital defects or after resection of neoplasms of the penis . Hypospadias is a congenital anomaly in which the urethra opens on the underside of the penis. Surgical repair of this condition places the urethra at the end of the penis.
Male circumcision is considered medically necessary when the individual has any of the following conditions: Risk reduction for males at high risk of HIV infection; or. Trauma to the foreskin requiring surgical treatment. Male circumcision is considered medically necessary when the individual is undergoing surgical repair ...
Inclusion or exclusion of a procedure, diagnosis or device code (s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.
The AUA notes that general anesthesia is generally required for circumcision beyond the newborn period. There are several conditions that create a medical need for circumcision beyond the newborn period. Phimosis is the inability to retract the foreskin. This condition can be physiologic or pathologic.