CSHCN 2009 > Physician > Benefits, Limitations, and Authorization Requirements

29.2.35.11 Circumcision

The CSHCN Services Program may reimburse providers for performing a medically necessary circumcision for clients who are 29 days of age or older (procedure code 54161).

Routine circumcision of a newborn during the newborn period and without an accompanying medical condition is not a benefit of the CSHCN Services Program. The newborn period is defined as the first 28 days of life. Circumcision of a female of any age is not a benefit of the CSHCN Services Program.

Authorization is required for a circumcision. Documentation should include the diagnosis and the specific medical necessity for the circumcision.

Refer to: Section 4.2, "Authorizations" for detailed information about authorization requirements.

Appendix B, "CSHCN Services Program Authorization and Prior Authorization Request," on page B-96.

If a circumcision is billed in addition to a hypospadias or epispadias repair, the circumcision is denied as part of another procedure. A circumcision billed in addition to other surgical procedures on the male genital or urinary system is paid according to multiple surgery reimbursement guidelines. Physicians may be reimbursed the lower of the billed amount or the amount allowed by Texas Medicaid. Claims submitted by an assistant surgeon for a circumcision are denied.