Sunday, November 20, 2022

CPT Codes for "Circumcision"

 "Circumcision" made its way into the medical field in the late 1800s when there were beliefs that touching one's genitalia was a source of ailments.  To this day there are claims that you may or may not believe.  Whether you believe the claims or not is not important here.

CPT codes are used in the medical field to handle billing for medical services.  They are maintained by an editorial panel of the American Medical Association:


"Circumcision" continues to be done without a pathology present.  In the USA it is more often done in the medical field as a preventative measure and/or to meet parents' religious and/or cosmetic beliefs.  The challenge with the CPT codes is that there is no differentiation between addressing an existing pathology and when there is not.  This makes it impossible for insurance companies (including Medicaid) to be able to only cover medically needed procedures.  You would think that the insurance companies would apply pressure on the AMA to correct this.

In 2022 there was a lawsuit in Massachusetts to stop Medicaid from paying for the non-therapeutic procedure:
Due to the Federal government's protection of Medicaid so that they do not take on any undue administrative burden, it failed and Medicaid in Massachusetts continues to cover the procedure.  If separate CPT codes were used, this administrative burden would not exist.

Here are the codes as they exist:

"Circumcision" is a euphemism that stems from the religious texts that state "circumcise the flesh of the foreskin."  When considering anatomical diagrams, what is removed is part or all of the prepuce.  I request that the CPT Editorial Panel add codes for prepuce amputation.  This would give the insurance companies the ability to continue covering medically necessary procedures (like a prepuce amputation or "posthectomy") and deny those that are not.

I have created the following petition to convince the AMA to do so: