These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
Prior authorization is required for circumcision.
Circumcision is generally covered subject to the indications listed below and per your plan documents.
Indications that are covered
Circumcision is covered for medically necessary reasons (in the opinion of the attending physician, a pathologic condition exists where circumcision is required), including but not limited to the following indications:
- Recurrent urinary tract infections.
Indications that are not covered
Circumcision is not covered for the following reasons, including but not limited to the following:
- Routine newborn circumcision not done for a medically necessary reason;
- When performed for religious practice;
- Phimosis alone is not considered a pathologic condition and does not support medical necessity for circumcision in infants and children.
If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.
Circumcision, using clamp or other device with regional dorsal penile or ring block
Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less)
Circumcision, surgical excision other than clamp, device, or dorsal slit, older than 28 days of age
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This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.
Portions of the contents of these coverage criteria relating to Minnesota Public Programs medical coverage criteria are taken directly from the Minnesota Health Care Programs Provider Manual at: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_008926#male
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- Hayashi, Y., Kojima, Y., Mizuno, K.,and Kohri, K. (2011) Prepuce: phimosis, paraphimosis, and circumcision.TheScientificWorldJOURNAL: TSW Urology 11, 289–301. DOI 10.1100/tsw.2011.31.
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